Multivariate Cox Regression Model Research Articles

Risk of second primary malignancies among survivors of cutaneous melanoma: A nationwide population-based study in the Republic of Korea

There is limited data on the risk of second primary malignancies (SPMs) in Asian melanoma survivors. This study aimed to identify the risk of SPMs in Asian melanoma survivors. Standardized incidence ratios (SIRs) were calculated for overall and specific SPMs. The risk factor for overall SPM development was analyzed using a multivariable Cox regression model. A total of 10,070 patients with melanoma were included in the study. Melanoma survivors exhibited an increased risk of overall SPM (SIR, 1.51; 95% confidence interval [CI], 1.34–1.70). Additionally, specific SPMs were more common among melanoma survivors, including nonmelanoma skin cancer, oral cavity and pharyngeal cancer, renal cancer, female breast cancer, lung cancer, pancreatic cancer, and liver cancer. Independent risk factors for overall SPM development included a Charlson Comorbidity Index ≥ 1 (adjusted hazard ratio [aHR], 1.41; 95% CI, 1.07–1.87), and a body mass index ≥ 25 kg/m2 (aHR, 1.47; 95% CI, 1.04–2.08). Inherent uncertainty related to diagnostic codes may exist. The risk of overall and specific SPMs was significantly elevated in Asian melanoma survivors, particularly among those with invasive melanoma. Among modifiable factors, a high body mass index (BMI) was associated with an increased risk of SPM.

Development of a Nomogram and Risk Grouping System for Predicting 1-Year Overall Survival of Patients With Atypical Teratoid/Rhabdoid Tumors.

Atypical teratoid/rhabdoid tumor (AT/RT) is a kind of central nervous system malignant tumor in children. In this study, we aimed to develop a practically clinical nomogram and risk grouping system to predict 1-year overall survival for patients with atypical teratoid/rhabdoid tumor. The nomogram was constructed based on the pediatric tumor registry of Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine. Fifty-four information-integrated patients with atypical teratoid/rhabdoid tumor were included from the database. Cox regression analyses were used to select independent prognostic factors. Based on the fitted multivariate Cox regression model, a nomogram of 1-year overall survival for atypical teratoid/rhabdoid tumor patients was generated. Moreover, the nomogram was validated by assessing its discrimination and calibration. In these patients, age at diagnosis, the extent of tumor resection, radiotherapy, and chemotherapy were included in the multivariate Cox regression model. Based on this multivariate Cox regression model, a nomogram of 1-year overall survival for atypical teratoid/rhabdoid tumor patients was generated. The nomogram had good discrimination (the concordance index was 0.781) and calibration curves showed no deviation from reference lines. Decision curve analysis demonstrated this nomogram was useful for clinical practice. The risk grouping system was built based on nomogram-derived risk scores, which could classify patients into 3 risk groups. Compared with the low-risk group, the risk of 1-year death was significantly higher in the intermediate-risk group (hazard ratio = 1.42, 95%, confidence intervals = 0.49-4.11) and high-risk group (hazard ratio = 9.78, 95% confidence intervals = 3.53-27.1). A nomogram and risk grouping system were built to predict for the 1-year overall survival of atypical teratoid/rhabdoid tumor patients. The nomogram could facilitate a personalized prognostic evaluation for atypical teratoid/rhabdoid tumor patients and help medical practitioners make better treatment.

Characteristics of injury deaths among homeless and non-homeless US veterans (2017–2021)

ObjectiveThe objective of this study is to assess whether experiencing homelessness may be associated with future risk of injury death and characterise these injury deaths by homelessness status among veterans...

Low birth weight and chronic kidney disease with progression to kidney failure in children.

It is unclear if low birth weight (LBW), preterm birth and small for gestational age (SGA) could synergistically cause chronic kidney disease (CKD) and end-stage kidney disease (ESKD). This cohort study was conducted to examine their individual and combined impacts on the development of CKD and ESKD in childhood. From the Taiwan Maternal and Child Health Database, we identified 1 477 128 newborns born between January 1, 2009, and December 31, 2016. We used a multivariable Cox regression model to assess the excess risk of CKD and ESKD in children with LBW/preterm/SGA. They were followed from birth until the occurrence of outcomes or until December 31, 2018, with an average follow-up of 5.78 years. This study included 1 361 071 infants with birth weight≥2500g (92.14%), 104 855 infants with low birth weight (1500g to<2500g) (7.10%), 6 843 infants with very low birth weight (1000g to<1500g) (0.46%), and 4 349 infants with extremely low birth weight (< 1000g) (0.29%). The multivariable-adjusted model showed that male infants with low birth weight were associated with an increased risk of CKD (aHR 1.20, 95%CI 1.08-1.32) and ESKD (aHR 1.64, 95%CI 1.37-1.97). Female infants with LBW had an increased risk of CKD (aHR 1.18, 95%CI 1.06-1.32) and ESKD (aHR 1.31, 95%CI 1.09-1.58) than those without LBW. In addition to LBW, infants with preterm or SGA condition also had a significantly and synergistically increased risk of CKD and ESKD compared to full-term infants. We found children with LBW, preterm birth, or small for gestational age had a significantly increased risk of CKD and ESKD compared to children without intrauterine growth restriction.

Predictive value of insulin resistance metabolic score for cardiovascular disease in Chinese arthritis patients: a prospective cohort study.

Although patients with arthritis have significantly increased cardiovascular disease (CVD) risk, effective prediction tools remain limited. This study aimed to evaluate the predictive value of the Metabolic Score for Insulin Resistance (METS-IR) for CVD events among Chinese patients with arthritis. Using data from the China Health and Retirement Longitudinal Study (CHARLS), we conducted a 7-year prospective cohort study (2011-2018) involving 1,059 patients with arthritis. The primary exposure was baseline METS-IR, and the primary outcome was incident CVD. Multivariate Cox regression models were used to analyze the association between METS-IR and CVD risk, adjusting for demographic characteristics and lifestyle factors. After adjusting for confounding factors, each quartile increase in METS-IR was associated with a 36% increased risk of CVD (HR = 1.36,95%CI : 1.14-1.61, p< 0.001). Compared with the lowest quartile, the highest quartile showed a 63% increased risk (HR = 1.63,95%CI : 1.12-2.37, p< 0.05), demonstrating a significant dose-response relationship (p for trend < 0.05). METS-IR serves as an effective tool for predicting CVD risk among Chinese patients with arthritis, providing new strategies for early risk identification and prevention.

Age and Tumor Stage Interplay in Intrahepatic Cholangiocarcinoma: Prognostic Factors, Mortality Trends, and Therapeutic Implications from a SEER-Based Analysis

Background: Intrahepatic cholangiocarcinoma (ICC), a malignancy originating from the epithelial cells of bile ducts, has shown a notable rise in its incidence over the years. It ranks as the second most frequent primary liver cancer after hepatocellular carcinoma. This study investigates how independent prognostic factors, specifically, age and tumor stage, interact to impact mortality in ICC patients. Furthermore, it examines the clinical features, survival rates, and prognostic indicators of ICC cases diagnosed between 2010 and 2017. Methods: Using data from 5083 patients obtained from the Surveillance, Epidemiology, and End Results (SEER) database, this study evaluated demographic and clinical factors alongside overall mortality (OM) and cancer-specific mortality (CSM). Variables achieving a p-value below 0.1 in univariate Cox regression analysis were incorporated into multivariate Cox regression models to identify independent prognostic factors. Hazard ratios (HRs) exceeding 1 were interpreted as markers of poor prognosis. Additionally, this study explored the interaction between age and tumor stage in shaping survival outcomes. Results: The multivariate Cox proportional hazards analysis indicated higher OM in males (HR = 1.19, 95% CI: 1.12–1.26, p &lt; 0.01) and residents of metropolitan counties with populations exceeding 250,000 (HR = 1.15, 95% CI: 1.01–1.31, p &lt; 0.05). Conversely, lower OM was observed in individuals aged 40–59 years (HR = 0.58, 95% CI: 0.38–0.89, p &lt; 0.05), those aged 60–79 years (HR = 0.65, 95% CI: 0.43–0.98, p &lt; 0.05), and patients who received radiation therapy (HR = 0.78, 95% CI: 0.72–0.85, p &lt; 0.01), chemotherapy (HR = 0.54, 95% CI: 0.51–0.58, p &lt; 0.01), or surgery (HR = 0.29, 95% CI: 0.26–0.31, p &lt; 0.01). For CSM, males exhibited higher risks (HR = 1.17, 95% CI: 1.10–1.25, p &lt; 0.01), as did individuals in metropolitan counties with populations over 250,000 (HR = 1.18, 95% CI: 1.03–1.35, p &lt; 0.05). Reduced CSM was observed in patients aged 40–59 years (HR = 0.52, 95% CI: 0.34–0.79, p &lt; 0.01), those aged 60–79 years (HR = 0.57, 95% CI: 0.38–0.86, p &lt; 0.01), and those undergoing radiation therapy (HR = 0.76, 95% CI: 0.70–0.83, p &lt; 0.01), chemotherapy (HR = 0.55, 95% CI: 0.51–0.59, p &lt; 0.01), or surgery (HR = 0.27, 95% CI: 0.25–0.30, p &lt; 0.01). When examining the interaction between age and tumor stage, higher OM was observed in patients aged 40–59 with tumors involving lymph nodes (HR = 1.26, 95% CI: 1.14–2.67, p &lt; 0.05). Similarly, CSM was elevated in patients aged 40–59 with lymph node involvement alone (HR = 2.60, 95% CI: 1.26–5.36, p &lt; 0.05) or with direct spread (HR = 2.81, 95% CI: 1.04–7.61, p &lt; 0.05). Among those aged 60–79, higher CSM was noted in cases with lymph node involvement only (HR = 2.24, 95% CI: 1.11–4.50, p &lt; 0.05) or lymph node involvement accompanied by direct extension (HR = 2.93, 95% CI: 1.10–7.82, p &lt; 0.05). Conclusions: This retrospective analysis, utilizing data from the SEER database, provides new insights into mortality patterns in intrahepatic cholangiocarcinoma (ICC). This study identifies a significant interplay between two key prognostic factors, emphasizing their collective role in influencing mortality outcomes. Despite the predominance of advanced-stage diagnoses, our analysis underscores the substantial survival benefits associated with treatment interventions, with surgical procedures demonstrating the most pronounced impact. These findings highlight the importance of recognizing patients who may benefit from timely and intensive therapeutic strategies. Furthermore, the results underscore the need for future prospective randomized studies to deepen our understanding of these interactions in ICC, particularly as advancements in precision oncology continue to refine patient care.

Time to recovery of neonatal sepsis and its predictors in public hospitals of North Shoa Zone, Central Ethiopia

BackgroundNeonatal sepsis remains one of the most common causes of morbidity and mortality among neonates in developing countries. It can cause severe morbidities and sequelae, even though patients survive. Prolonged recovery time of neonatal sepsis leads to hospitalization, increased cost of treatments, antimicrobial resistance, disseminated intravascular coagulation, respiratory failure, septic shock, brain lesions, renal failure, and cardiovascular dysfunction, and eventually death. Thus, this study aimed to identify the time-to-recovery of neonatal sepsis and its predictors among newborns admitted to public hospitals in the North Shoa Zone, Central Ethiopia.MethodsA retrospective cohort study was conducted among 508 septic neonates admitted to selected public hospitals in the North Shoa Zone between March 1, 2021, and March 1, 2023. A systematic random sampling method was used to select eligible medical records. The data were collected through the open data kit (ODK) Collect Android app and consequently exported to STATA version 17 for analysis. The data were analyzed using both univariable and multivariable Cox regression models. The adjusted hazard ratio (AHR) with its corresponding 95% confidence interval (CI) was employed.ResultsOf all septic neonates, 441 were recovered. The predictors of time-to-recovery of neonatal sepsis were premature rupture of membrane (PROM) (AHR = 0.37; 95% CI: 0.21, 0.63), intrapartum fever (AHR = 0.49; 95% CI: 0.32, 0.75), chest-indrawing (AHR = 0.50; 95% CI: 0.36, 0.68), fifth-minute appearance, pulse, grimace, activity, and respiration (Apgar) score less than seven (AHR = 0.54; 95% CI: 0.38, 0.77), gestational age between 37 and 42 weeks (AHR = 1.35; 95% CI: 1.06, 1.70), septic shock (AHR = 0.52; 95% CI: 0.31, 0.85).ConclusionThe median time to recovery from neonatal sepsis in this study was comparable to the previous studies. Premature rupture of membranes, intrapartum fever, term gestational age, low fifth minute Apgar score, chest indrawing, and septic shock were the predictors of time-to recovery of neonatal sepsis. Therefore, birth attendants are advised to closely adhere to the obstetrics management protocols when providing care for women who have intrapartum fever and premature rupture of membranes, as this will help to minimize neonatal sepsis and the subsequent delay in recovery.

Proton pump inhibitors and all-cause mortality risk among cancer patients

BACKGROUND Proton pump inhibitors (PPIs) are widely used, including among cancer patients, to manage gastroesophageal reflux and other gastric acid-related disorders. Recent evidence suggests associations between long-term PPI use and higher risks for various adverse health outcomes, including greater mortality. AIM To investigate the association between PPI use and all-cause mortality among cancer patients by a comprehensive analysis after adjustment for various confounders and a robust methodological approach to minimize bias. METHODS This retrospective cohort study used data from the TriNetX research network, with electronic health records from multiple healthcare organizations. The study employed a new-user, active comparator design, which compared newly treated PPI users with non-users and newly treated histamine2 receptor antagonists (H2RA) users among adult cancer patients. Newly prescribed PPIs (esomeprazole, lansoprazole, omeprazole, pantoprazole, or rabeprazole) users were compared to non-users or newly prescribed H2RAs (cimetidine, famotidine, nizatidine, or ranitidine) users. The primary outcome was all-cause mortality. Each patient in the main group was matched to a patient in the control group using 1:1 propensity score matching to reduce confounding effects. Multivariable Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence interval (CI). RESULTS During the follow-up period (median 5.4 ± 1.8 years for PPI users and 6.5 ± 1.0 years for non-users), PPI users demonstrated a higher all-cause mortality rate than non-users after 1 year, 2 years, and at the end of follow up (HRs: 2.34-2.72). Compared with H2RA users, PPI users demonstrated a higher rate of all-cause mortality HR: 1.51 (95%CI: 1.41-1.69). Similar results were observed across sensitivity analyses by excluding deaths from the first 9 months and 1-year post-exposure, confirming the robustness of these findings. In a sensitivity analysis, we analyzed all-cause mortality outcomes between former PPI users and individuals who have never used PPIs, providing insights into the long-term effects of past PPI use. In addition, at 1-year follow-up, the analysis revealed a significant difference in mortality rates between former PPI users and non-users (HR: 1.84; 95%CI: 1.82-1.96). CONCLUSION PPI use among cancer patients was associated with a higher risk of all-cause mortality compared to non-users or H2RA users. These findings emphasize the need for cautious use of PPIs in cancer patients and suggest that alternative treatments should be considered when clinically feasible. However, further studies are needed to corroborate our findings, given the significant adverse outcomes in cancer patients.

Prognostic value of coronary plaque composition in symptomatic patients with obstructive coronary artery disease.

To determine whether plaque composition analysis defined by cardiac CT can provide incremental prognostic value above coronary artery disease (CAD) burden markers in symptomatic patients with obstructive CAD. Between 2009 and 2019, a multicentric registry included all consecutive symptomatic patients with obstructive CAD (at least one ≥ 50% stenosis on CCTA) and was followed for major adverse cardiovascular (MACE) defined by cardiovascular death or nonfatal myocardial infarction. Each coronary segment was scored visually for both the degree of stenosis and composition of plaque, which were classified as non-calcified, mixed, or calcified. To assess the prognostic value of each CCTA findings, different multivariable Cox regression models were used: model 1: clinical (traditional risk factors); model 2: model 1 + CAD burden (number of proximal segments with stenosis ≥ 50% + number of vessels with obstructive CAD); and model 3: model 2 + plaques feature (number of segments with non-calcified plaque). Of 2312 patients (mean age 70 ± 12 years, 46% men), 319 experienced a MACE (13.8%) (median follow-up: 6.7 years (5.9-9.1)). The number of proximal segments with ≥ 50% stenosis, the number of vessels with obstructive CAD, and the number of segments with non-calcified plaque were all independently associated with MACEs (all p < 0.001). The addition of plaque composition analysis (model 3) showed the best improvement in model discrimination and reclassification (C-statistic improvement = 0.03; net reclassification improvement = 28.6%; integrative discrimination index = 5.4%, all p < 0.001). In this population, the analysis of coronary plaque composition had an incremental prognostic value to predict MACEs above a model combining traditional risk factors and CAD burden. Question Several coronary computed tomography angiography (CCTA) studies have shown the potential interest of plaque composition analysis, which can be further evaluated. Findings In symptomatic patients with obstructive coronary artery disease (CAD), plaque composition analysis had an incremental prognostic value above a model combining traditional risk factors and CAD burden. Clinical relevance In symptomatic patients with obstructive CAD, plaque composition analysis using CCTA has a strong incremental prognostic value above a model combining traditional risk factors and CAD burden, thus translating into a more accurate long-term major adverse cardiovascular event prediction.

Associations of the serum 25-hydroxyvitamin D with mortality among patients in osteopenia or osteoporosis.

The correlation between serum vitamin D and mortality in patients with osteopenia or osteoporosis remains unclear. Therefore, this study examined the relationship between serum 25-hydroxy vitamin D [(25(OH)D] and mortality in patients with osteopenia or osteoporosis. This prospective cohort study included patients with osteopenia or osteoporosis from the National Health and Nutrition Examination Survey from 2001 to 2018. Multivariate Cox regression models examined the correlation between serum 25(OH) D and all-cause mortality, cardiovascular mortality (CVD), and cancer mortality. The cohort included 9282 adult participants with a median follow-up period of 97.01 months, including 1394 all-cause deaths, 413 CVD-related deaths, and 322 cancer deaths. In fully adjusted models, higher serum 25(OH) D levels (≥75.0 nmol/L) were associated with a lower risk of all-cause mortality (hazard ratio 0.54, 95 % confidence interval 0.41 to 0.73) and cardiovascular death (0.47, 0.29 to 0.76), using participants with low 25(OH) D levels (<25 nmol/L) as the reference. In addition, we found an L-shaped non-linear dose-response relationship between serum 25(OH) D and all-cause and cardiovascular mortality, with inflection points of 38.8 nmol/L and 53.6 nmol/L, respectively. Higher serum 25(OH) D concentrations are strongly associated with a diminished risk of all-cause and CVD mortality in patients with osteopenia or osteoporosis, this association has a threshold effect. More in-depth intervention studies are needed to clarify underlying mechanisms.

P0750 Association between intestinal fibrosis and clinical and surgical recurrence after intestinal resection in stenotic Crohn's disease patients

Abstract Background Despite recent advances in the medical care of Crohn's disease (CD), most patients, particularly those with stenosis, still require intestinal resection during their disease course. However, more than half of the patients experience postoperative recurrence. Intestinal fibrosis is an important pathological feature of stenotic Crohn's disease. We aim to investigate the association between fibrosis at the site of intestinal stenosis and normal area and risk of clinical and surgical recurrence after first intestinal resection in patients with stenotic Crohn's disease. Methods A retrospective, multi-center study was conducted on stenotic Crohn's disease patients who received first intestinal resection between January 2010 and July 2023. The most representative pathological slides from the resected stenotic intestinal tissues and normal slides from the normal tissues were selected. We used Masson's trichrome staining to visualize collagen fibers and calculated the proportion of collagen fiber area in the slides using the Image-Pro-Plus software to assess the degree of intestinal fibrosis. Baseline information and postoperative clinical recurrence were collected through electronic medical record systems and telephone follow-up. Survival analysis and univariate and multivariate Cox regression models were used to assess the impact of intestinal fibrosis on clinical and surgical recurrence. Results 257 patients were included in this study. 94 (36.5%) and 25 (9.7%) of the patients experienced clinical and surgical recurrence during the follow-up period, respectively. In the univariate cox analysis, high degree transmural intestinal fibrosis at stenotic area was significantly associated with clinical recurrence (HR 4.94, 95%CI 2.72-8.96, P&amp;lt;0.001) and surgical recurrence (HR 4.45, 95%CI 1.45-13.72, P=0.009). This association remained significant when considering fibrosis only in the mucosa, submucosa, muscular layers of stenotic area, or in the normal area. In the multivariate cox analysis, transmural fibrosis was still related to clinical recurrence. Conclusion The degree of transmural fibrosis at the site of intestinal stenosis and normal area was significantly associated with clinical recurrence after first intestinal resection in patients with stenotic Crohn's disease. Intestinal fibrosis should be considered in postoperative treatment and follow-up decision-making.

P1279 Associations of accelerometer-measured moderate-to-vigorous physical activity with bowel resection risk and mortality among individuals with inflammatory bowel disease: a prospective cohort study

Abstract Background There is limited consensus on physical activity recommendations for inflammatory bowel disease (IBD) patients due to insufficient high-quality evidence. We investigated the associations of accelerometer-measured moderate-to-vigorous physical activity (MVPA) with bowel resection risk and mortality among affected individuals. Methods We collected data from 1,303 UK Biobank participants with IBD diagnosis and device-measured physical activity. MVPA was classified based on data measured by wrist-worn accelerometers over a 7-day period. MVPA patterns were defined as inactive, active weekend warrior, and regularly active. Associations were estimated using multivariable Cox regression models. Results During a median follow-up of 7.8 years, 56 incident bowel resection cases and 86 deaths were documented. Compared to those with the lowest tertile, participants with the highest tertile of MVPA duration had lower risks of bowel resection (HR, 0.44; 95% CI, 0.22-0.86) and mortality (HR, 0.49; 95% CI, 0.27-0.89). MVPA duration is linearly associated with bowel resection (P non-linear = 0.13) while its dose-response relationship with mortality plateaus at approximately 58 min/day (P non-linear = 0.02). The active weekend warrior pattern was inversely associated with bowel resection (HR, 0.28; 95% CI, 0.12-0.65), the regularly active pattern was inversely associated with both bowel resection (HR, 0.37; 95% CI, 0.19-0.69) and mortality (HR, 0.53; 95% CI, 0.31-0.91) compared to the inactive. Conclusion Longer accelerometer-measured MVPA was associated with reduced bowel resection risk and mortality. The regularly active pattern may be the optimal choice for individuals with IBD, while the active weekend warrior pattern still provides health benefits compared to being inactive.

P0908 Prognostic Nomogram Incorporating Limberg Score for Predicting Bowel Surgery in Patients with Ulcerative Colitis

Abstract Background This study aimed to assess the role of intestinal ultrasound (IUS) in monitoring and predicting long-term bowel surgery in patients with ulcerative colitis (UC). Methods This retrospective study analyzed documented IUS examinations of UC patients from a prospective inflammatory bowel disease registry. A nomogram was constructed to predict bowel surgery based on factors identified by both multivariate Cox and logistic regression model. Model performance was assessed using receiver-operating characteristic (ROC) curves and decision curve analysis (DCA). Results A total of 171 patients were enrolled. Significant correlations were observed between IUS parameters and disease activity as assessed by colonoscopy, as well as with other inflammatory indices. During a median follow-up of 32 months, 12 patients (7.02%) underwent UC-related bowel surgery. Factors associated with bowel surgery identified by the Cox regression included the Limberg score (OR 3.86, 95% CI 0.98−15.26, p=0.054), steroids use (OR 7.31, 95% CI 0.85−62.51, p=0.069), perianal lesions (OR 37.19, 95% CI 1.94−712.34, p=0.016), and age at diagnosis (OR 1.08, 95%CI 1.02−1.13, p=0.007). A nomogram incorporating these factors was established. Both ROC curve and DCA analysis indicated that the nomogram, which included the Limberg score, had an area under the curve (AUC) of 0.872 and a C-Index of 0.875. The nomogram based on logistic regression analysis also showed good performance. Conclusion We developed and validated a prognostic nomogram incorporating the Limberg score to identify patients with UC most likely to require bowel surgery. This nomogram can improve risk stratification and aid personalized therapeutic decisions for UC patients.

P1034 Prognostic value of short-term endo-histological outcomes in moderate-to severe ulcerative colitis patients on tofacitinib treatment – prospective cohort study

Abstract Background Data are scarce on the deep remission of tofacitinib (TOFA) in moderate-to severe ulcerative colitis (UC), however, it can fundamentally change disease course and behaviour. Methods This was a prospective cohort study, assessing the short-term effectiveness of TOFA in UC patients. Baseline was the day of induction of TOFA. Clinical, biochemical, endoscopic and histological activities were assessed at baseline and at week 8 and 12, and we collected one-year treatment persistence. Primary outcome was week 12 histological remission (HR), defined as Nancy score&amp;lt;1 and endoscopic Mayo score (eMayo)≤1. Secondary outcomes were week 12 corticosteroid-free remission (CSFR), defined as clinical remission (CR; partial Mayo score [pMayo]&amp;lt;2 with a rectal bleeding subscore of 0) and C-reactive protein (CRP) ≤5 mg/L and endoscopic remission (eMayo score ≤1), furthermore, one-year treatment persistence were assessed. Data was handled by intention to treat analysis. We performed multivariable logistic, Cox-regression and linear regression models to control potential confounders and to reduce bias. The most reliable models were selected based on ROC analyzes with highest area under the curve (AUC). Results A total of 75 moderate-to severe UC patients (mean age 38.4 ± 12.1; male/female ratio 32/44) were involved in our prospective cohort study. In total, 7 patients (9.2%) achieved histological remission, while 20 patients (26.7%) achieved endoscopic remission. We found, that one-year treatment persistence was strongly influenced by week 12 endoscopic remission (β=3.79 [95% CI: 1.21 – 6.37]), but not by HR (β=1.58 [95% CI: -0.74 – 3.89]). In total, 34 patients (44.7%) were in CSFR at week 12, and higher baseline pMayo score decreased (OR=0.64 [95% CI: 0.43 – 0.94]), while albumin increased (OR=1.33 [95% CI: 1.01 – 1.76]) the chance of achieving the outcome (AUC = 0.93). Conclusion Based on our prospective cohort study, short-term HR is still a hard-to-reach endpoint in moderate-to-severe UC on TOFA. We found, that one-year treatment persistence is influenced by endoscopic mucosal healing, but not by HR, however, it should be enhanced, that as only a few patients achieved HR, the necessary statistical power was lacking.

Effect of β-blocker on clinical outcomes in patients with traumatic brain injury: a retrospective propensity-matched study

BackgroundTraumatic brain injury (TBI) represents a significant public health challenge due to its complex management. β-blockers may offer neuroprotective benefits, but their impact on TBI outcomes remains unclear. This study aims to evaluate the effect of β-blocker use on clinical outcomes in TBI patients.MethodsThis retrospective cohort study included adult TBI patients, categorized into β-blocker and non-β-blocker groups. Propensity score matching (PSM) was utilized to balance baseline characteristics. Mortality was assessed through the application of multivariable Cox regression models and Kaplan–Meier survival curves. Subgroup analyses examined the consistency of the results.ResultsA total of 1,516 patients were included in the study, with 750 receiving β-blocker therapy and 766 not receiving it. After PSM, 473 pairs of patients were matched. The analysis indicated that β-blockers significantly reduce 28-day mortality (HR 0.43, 95% CI: 0.31–0.60, P &amp;lt; 0.001). However, patients receiving β-blocker had considerably longer hospital stays (7.89 days vs. 5.45 days, P &amp;lt; 0.001) and ICU stays (2.94 days vs. 2.33 days, P &amp;lt; 0.001).Conclusionβ-blocker therapy is associated with improved short-term outcomes in patients with TBI, particularly in those with mild (GCS 13–15) and severe (GCS 3–8) TBI. However, no significant benefit was observed in patients with moderate TBI (GCS 9–12). This therapy may also prolong hospital and ICU stays.

Evaluating survival outcomes and treatment recommendations in resectable gastric cancer

No consensus exists on the optimal therapy for resectable gastric cancer (GC) and gastroesophageal junction (GEJ) tumors, including the effectiveness of chemoradiotherapy versus perioperative chemotherapy (PC). Our study aimed to compare overall survival (OS) outcomes associated with the recommended treatment modalities for GC and GEJ tumors and evaluate treatment trends from 2010 to 2020. A national registry cohort identified patients with ≥ cT2 nonmetastatic GC and GEJ cancer. Treatment modalities were classified as neoadjuvant chemotherapy (NC), neoadjuvant chemoradiotherapy (NCR), PC, adjuvant chemotherapy (AC), and adjuvant chemoradiation (ACR). Kaplan-Meier curve and multivariable Cox regression models evaluated factors associated with OS. A cohort of 7665 patients were included. Patients who received PC had the highest OS (median 86.80 months, 95% CI 73.40-NE), while chemoradiotherapy in the neoadjuvant and adjuvant settings had worse OS than PC and NC (NCR median 47.15 months, 95% CI 44.58–52.27, and ACR median 52.67 months, 95%CI 42.78–63.93). The Cox proportional hazards model showed that NCR and NC had worse survival than PC (HR 1.74, 95% CI 1.50–2.02, p < 0.001 and HR 1.26, 95% CI 1.10–1.44, p = 0.0008, respectively). Additionally, the most utilized modality during 2020 was NC (35.8%), followed by PC (28.0%) and NCR (24.9%). The utilization of PC and NC had the most substantial rise between 2010 and 2020, increasing by 11.0%. The study demonstrates the association of PC with improved OS outcomes for nonmetastatic GC and GEJ tumors. Therapies combining radiation with chemotherapy and extended lymph node dissection correlated with a worse prognosis compared to PC and NC. Despite the association with improved outcomes, national data reveals low utilization rates for PC.

P1197 Progression to colorectal cancer or high-grade dysplasia in individuals with inflammatory bowel disease and low-grade dysplasia: A cohort study of risk factors and incidence

Abstract Background Individuals with inflammatory bowel disease (IBD) face an increased risk for colorectal cancer (CRC) and high grade dysplasia (HGD) compared with individuals without IBD.1,2 Low-grade dysplasia (LGD) is recognized as a key risk factor for HGD and CRC development in IBD.3 However, the risk for progression from LGD to HGD or CRC is still debated. Studies report diverging results and are often limited by small sample sizes and selection bias.4 The influence of diagnosis-year and medications is particularly underexplored. Therefore, we sought to utilize the Danish healthcare registers to examine the impact of candidate risk factors for progression from LGD to either HGD or CRC among Danish individuals with IBD. Methods We conducted a cohort study, including all Danish individuals diagnosed with IBD and LGD between 1977 and 2022. IBD with LGD was defined as individuals with a LGD diagnosis up to 180 days before or any time after their first IBD diagnosis, using the latest date as index date. Individuals with a colectomy, HGD, or CRC before the index date were excluded. We investigated the cumulative incidence of progression to HGD or CRC, treating death as a competing risk. A univariate Cox regression model was used to assess hazard ratios (HRs) for potential risk factors. Variables with a P-value of ≤ 0.1 were included in the final multivariable cox regression model. Results We included 7,082 individuals with IBD and LGD for further analysis. As illustrated in figure 1 the cumulative incidence of progression from LGD to HGD or CRC at 15 years post-index was 6.70% (95% CI: 5.93–7.54). Several risk factors were identified (table 1). Of particular interest was the influence of index-year and treatment with prednisone and anti-TNF-α. In the final model, we observed a reduction in progression risk over time, with a decreased risk for progression in the period 2018-2021 (HR: 0.32 [95% CI: 0.21-0.50]) and 2015-2018 (HR: 0.53 [95% CI: 0.34-0.69]) relative to 1977-2010. High-dose prednisone treatment was associated with progression to HDG or CRC (HR: 1.77 [95% CI: 1.23-2.57]), whereas anti-TNF-α treatment was not (HR: 0.81 [95% CI:0.38–1.74]). Conclusion Among Danish individuals with IBD the risk of progression from LGD to HGD or CRC declined over time. Treatment with High-dose prednisone was associated with an increased risk of progression, whereas anti-TNF-α treatment was not. We speculate that recent advancements in biological treatments of IBD, the implementation of 'treat-to-target' strategies, and improved detection and resection of LGD lesions, may partly explain declining progression risk.

The influence of baseline platelet on mortality risk in stroke and cancer patients: a cross-sectional analysis of the NHANES database

BackgroundPlatelet count and function may be closely related to survival and prognosis of stroke and cancer. However, little is known on the impact of platelet count on the patients with a history of stroke and cancer. This study aimed to examine the association between baseline platelet level and all-cause mortality in this population using a cross-sectional analysis.MethodsParticipants with a history of stroke and cancer were selected from the database of the National Health and Nutrition Examination Survey from 2007 to 2018. A maximum selected rank statistic was conducted to determine platelet cutoff with the most significant association with mortality. The association between platelet and mortality was characterized visually using restricted cubic spline (RCS). Weighted multivariable Cox regression models were performed to evaluate the association between platelet count and mortality. Time-dependent receiver operating characteristic (ROC) analysis was conducted to assess the accuracy of platelet count in predicting mortality.ResultsForty-three (43/113, 38.05%) stroke patients with cancer were alive at a median follow-up of 42 months (interquartile range, 23–74 months). The RCS analysis demonstrated a linear relationship between platelet and mortality (nonlinear, p = 0.352). Mortality in higher-platelet group (> 209 × 109/L, n = 57) was decreased than lower-platelet group (≤ 209 × 109/L, n = 56) (Model 1 HR 0.43, 95% CI 0.24—0.77, p = 0.005) (Model 2 HR 0.58, 95% CI 0.35—0.96, p = 0.03). Subgroup analyses showed no significant interaction between platelet and age, sex, BMI, WBC and neutrophil. The areas under time-dependent ROC curve of the 1-, 2-, 3-, 4- and 5-year survival rates were 0.54, 0.55, 0.57, 0.53, 0.59 for mortality of stroke patients with cancer.ConclusionsLower platelet count may be an independent predictor of all-cause mortality in population with a history of stroke and cancer. This result may provide valuable insights for the long-term management in stroke patients with cancer.

Effect of fertility desire-based service on HIV seroconversion among serodiscordant partners: A 12-year retrospective cohort study.

Fertility desire-based service guided by behavioral theory is a potential strategy to mitigate the HIV transmission risk, while related evidence remains scarce. We examined the long-term effect of theory-guided fertility desire-based services on HIV seroconversion between seropositive/seronegative partners in areas with high HIV prevalence and a cultural emphasis on fertility in China. We established a retrospective cohort by recruiting 8,653 seropositive partners with seronegative partners between January 1, 2009, and December 31, 2020, in Liangshan, China. The differences in HIV seroconversion between partners who received fertility desire-based services guided by the extended Information-Motivation-Behavioral Skills (IMB) model and those who did not were estimated, based on multivariable and inverse probability weighting (IPW) adjusted multivariable Cox regression models. Subgroup analysis was conducted based on participants' demographic and HIV-related characteristics. Among the 8,653 HIV-seropositive partners, 7,958 (92.0%) and their seronegative partners received fertility desire-based services. At the end of the 12-year follow up, 18 seronegative partners who did not receive fertility desire-based services experienced HIV seroconversion (incidence density: 7.4/1,000 person-years), while 98 seronegative partners receiving such services exhibited HIV seroconversion (3.4/1,000 person-years). Fertility desire-based services significantly reduced the risk of HIV seroconversion according to multivariable (HR=0.32, 95%CI: 0.19-0.53) and IPW-adjusted multivariable Cox regression models (HR=0.48, 95%CI: 0.27-0.84). The effect of fertility desire-based services was more pronounced in males and those above 40 years old. Fertility desire-based services based on the extended IMB model may help reduce the HIV transmission risk between seropositive/seronegative partners in areas with high HIV prevalence.

The efficacy and safety of sodium-glucose cotransporter 2 inhibitors in patients aged over 80years with heart failure.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors (SGLT2i) have demonstrated effectiveness in reducing cardiovascular death and heart failure hospitalization (HFH). However, the efficacy and safety of SGLT2 inhibitors in elderly patients with poor general status, such as very low bodyweight or low nutritional status, who are not included in randomized controlled trials, has not yet been examined. In a real-world setting, the introduction of SGLT2 inhibitors to such elderly patients is a very difficult decision to make. We therefore examined the efficacy and safety of these drugs in elderly heart failure patients in a real-world setting. In Kokura Memorial Hospital, a retrospective study was conducted on 1559 patients over 80years old hospitalized for HF between 2018 and 2023. Among them, 1326 were included in the non-SGLT2i group and 233 in the SGLT2i group. A multivariate Cox regression model was used to compare the risk of primary composite outcome (all-cause death and HFH) and secondary safety composite outcome (ischaemic stroke, urinary tract infection and dehydration) at 1year post-discharge between the two groups. The cumulative 1year incidence of the composite outcome was significantly higher in the non-SGLT2i group (47.3% vs. 31.6%, P<0.01). SGLT2 inhibitors independently reduced the risk of all-cause death [adjusted hazard ratio (HR): 0.58, 95% confidence interval (CI): 0.39-0.87, P<0.01] and HFH (adjusted HR: 0.69, 95% CI: 0.52-0.91, P<0.01), whereas the risk of safety composite events was not increased (adjusted HR: 0.80, 95% CI: 0.49-1.29, P=0.36). Subgroup analysis showed no significant interactions between age, diabetes, body mass index, left ventricular ejection fraction, clinical frailty scale, geriatric nutritional risk index and SGLT2 inhibitors consistently reduced composite outcomes across all strata. Similarly, SGLT2 inhibitors did not increase safety composite outcomes at any strata. SGLT2 inhibitors reduce the risk of all-cause death and HFH without increasing adverse events, even in patients over 80years old. It may be that SGLT2 inhibitors are effective and safe in patients who are basically hesitant to be introduced to SGLT2 inhibitors, such as those with high frailty, low nutritional status or very low bodyweight.