Current Screening Research Articles

Methylated Circulating Tumor DNA in Blood as a Tool for Diagnosing Lung Cancer: A Systematic Review and Meta-Analysis.

Lung cancer is the leading cause of cancer-related deaths, and early detection is crucial for improving patient outcomes. Current screening methods using computed tomography have limitations, prompting interest in non-invasive diagnostic tools such as methylated circulating tumor DNA (ctDNA). The PRISMA guidelines for systematic reviews were followed. The electronic databases MEDLINE, Embase, Web of Science, and Cochrane Library were systematically searched for articles. The search string contained three main topics: Lung cancer, blood, and methylated ctDNA. The extraction of data and quality assessment were carried out independently by the reviewers. In total, 33 studies were eligible for inclusion in this systematic review and meta-analysis. The most frequently studied genes were SHOX2, RASSF1A, and APC. The sensitivity and specificity of methylated ctDNA varied across studies, with a summary sensitivity estimate of 46.9% and a summary specificity estimate of 92.9%. The area under the hierarchical summary receiver operating characteristics curve was 0.81. The included studies were generally of acceptable quality, although they lacked information in certain areas. The risk of publication bias was not significant. Based on the findings, methylated ctDNA in blood shows potential as a rule-in tool for lung cancer diagnosis but requires further research, possibly in combination with other biomarkers.

Motivation towards first trimester screening for preeclampsia among pregnant women in Denmark: A cross-sectional questionnaire study.

The aim of this cross-sectional questionnaire study was to investigate motivation to participate in a possible new screening for preeclampsia in the first trimester of pregnancy among Danish pregnant women through a questionnaire based on Theory of Planned Behavior developed for this specific purpose. The new screening combines maternal characteristics with mean arterial pressure, uterine artery pulsatility index and biochemical markers to predict the risk of preeclampsia, whereas the current Danish screening uses maternal characteristics alone. Participation was offered to a proportion of women attending a first or a second trimester screening scan at two University Hospitals in Copenhagen. The questionnaire was set up in REDCap® and answers were entered directly into the database, which was accessed via a QR-code. We invited 772 pregnant women to participate in the questionnaire survey between November 2021 and April 2022 at Copenhagen University Hospital Rigshospitalet (study site one) (n = 238) and Copenhagen University Hospital Hvidovre (study site two) (n = 534). The response rate was 71.8% (171/238) at study site one and 33.9% (181/534) at study site two. A total of 352 women were included in the study (total participation rate 45.6%). Most women had a positive attitude towards preeclampsia screening in pregnancy, and 99.4% said they would participate in a risk assessment for preeclampsia if given the opportunity. A total of 97.4% answered "yes" to whether a first trimester preeclampsia screening should be offered to all pregnant women in Denmark. Positive motivation to participate in preeclampsia screening was correlated with having a network with a positive attitude towards preeclampsia screening. The results of this study indicate that Danish pregnant women have a positive attitude towards participation in a first trimester screening for preeclampsia. This observation might be useful in relation to possible future implementation in Denmark.

Parental Refusals of Blood Transfusions from COVID-19 Vaccinated Donors for Children Needing Cardiac Surgery

There is a growing trend of refusal of blood transfusions from COVID-19 vaccinated donors. We highlight three cases where parents have refused blood transfusions from COVID-19 vaccinated donors on behalf of their children in the setting of congenital cardiac surgery. These families have also requested accommodations such as explicit identification of blood from COVID-19 vaccinated donors, directed donation from a COVID19 unvaccinated family member, or use of a non-standard blood supplier. We address the ethical challenges posed by these issues. We describe the current screening and safety processes for standard blood donation and explore the importance of donor anonymity and challenges with directed donation and non-standard blood suppliers. We present an ethical framework using the Best Interest Standard, the Zone of Parental Discretion, and the Harm Principle when considering these refusals. Finally, we provide recommendations for how to approach these requests as they potentially become more commonplace in pediatrics.

HTRS2023.P3.1 Iron deficiency in a large pediatric comprehensive bleeding disorders clinic: current screening practice and iron deficiency prevalence

HTRS2023.P3.1 Iron deficiency in a large pediatric comprehensive bleeding disorders clinic: current screening practice and iron deficiency prevalence

Screening Practices for Breast and Nonbreast Cancers in High-Risk Mutation Carriers

IntroductionWomen with breast cancer often undergo genetic testing and may have a pathogenic variant associated with multiple cancers. This study examines the current screening practices for breast and nonbreast cancers in mutation carriers. MethodsAn institutional retrospective chart review of patients with BRCA1, BRCA2, ATM, CHEK2, BARD1, BRIP1, PALB2, and TP53 mutations were identified. Adherence to recommended screening based on National Comprehensive Cancer Network guidelines was analyzed. ResultsSix hundred sixty-two patients met inclusion criteria: 220 patients with BRCA1, 256 patients with BRCA2, 58 patients with PALB2, 51 patients with ATM, 48 patients with CHEK2, 14 patients with BRIP1, 10 patients with BARD1, and 5 patients with TP53. Overall, 214 (46%) of eligible patients completed recommended breast imaging. Of 106 patients eligible for pancreatic cancer screening, 20 (19%) received a magnetic resonance cholangiopancreatography and 16 (15%) received an endoscopic ultrasound. On multivariable analysis, age was associated with improved breast imaging adherence: patients in age groups 40-55 (adjusted odds ratio 2.05, 95% confidence interval 1.18-3.55) and age 56-70 (adjusted odds ratio 2.16, 95% confidence interval 1.18-3.95, P = 0.012) had better adherence than younger patients. ConclusionsIncreases in genetic testing and updates to National Comprehensive Cancer Network guidelines provide an opportunity for improved cancer screening. While recommended breast cancer screenings are being completed at higher rates, there is a need for clear protocols in this high-risk population.

Predictive Value of Malnutrition, Identified via Different Nutritional Screening or Assessment Tools, for Functional Outcomes in Patients with Stroke: A Systematic Review and Meta-Analysis.

Malnutrition affects more than half of patients with stroke. Although malnutrition leads to more deaths, a longer hospital stay, and higher costs, there is still a lack of consensus regarding the impact of malnutrition on physical functional outcomes in patients with stroke, and there are large differences in the diagnostic effects of nutritional screening or assessment tools for malnutrition. This study aimed to explore the impact of malnutrition in patients with stroke and assess the significance of current nutritional screening and assessment tools for these patients. Six databases were systematically searched until October 2022. Cohort studies meeting the eligibility criteria were included. Pooled effects were calculated using random-effects models. Twenty-six studies with 21,115 participants were included. The pooled effects of malnutrition on poor functional outcome, FIM points, and dysphagia were OR = 2.72 (95% CI = 1.84-4.06), WMD = -19.42(95% CI = -32.87--5.96), and OR = 2.80 (95% CI = 1.67-4.67), respectively. Malnutrition adversely affects the recovery of physical and swallowing functions in patients with stroke. Nutritional assessments consistently predict the outcomes of physical function in patients with stroke.

Heart Failure Assessment Using Multiparameter Polar Representations and Deep Learning.

Heart failure refers to the inability of the heart to pump enough amount of blood to the body. Nearly 7 million people die every year because of its complications. Current gold-standard screening techniques through echocardiography do not incorporate information about the circadian rhythm of the heart and clinical information of patients. In this vein, we propose a novel approach to integrate 24-hour heart rate variability (HRV) features and patient profile information in a single multi-parameter and color-coded polar representation. The proposed approach was validated by training a deep learning model from 7,575 generated images to predict heart failure groups, i.e., preserved, mid-range, and reduced left ventricular ejection fraction. The developed model had overall accuracy, sensitivity, and specificity of 93%, 88%, and 95%, respectively. Moreover, it had a high area under the receiver operating characteristics curve (AUROC) of 0.88 and an area under the precision-recalled curve (AUPR) of 0.79. The novel approach proposed in this study suggests a new protocol for assessing cardiovascular diseases to act as a complementary tool to echocardiography as it provides insights on the circadian rhythm of the heart and can be potentially personalized according to patient clinical profile information.Clinical relevance- Implementing polar representations with deep learning in clinical settings to supplement echocardiography leverages continuous monitoring of the heart's circadian rhythm and personalized cardiovascular medicine while reducing the burden on medical practitioners.

Cancer screening and management in the transgender population: Review of literature and special considerations for gender affirmation surgery.

Literature focused on cancer screening and management is lacking in the transgender population. To action to increase contributions to the scientific literature that drives the creation of cancer screening and management protocols for transgender and gender nonconforming (TGNC) patients. We performed a systematic search of PubMed on January 5th, 2022, with the following terms: "TGNC", OR "transgender", OR "gender non-conforming", OR "gender nonbinary" AND "cancer screening", AND "breast cancer", AND "cervical cancer", AND "uterine cancer", AND "ovarian cancer", AND "prostate cancer", AND "testicular cancer", AND "surveillance", AND "follow-up", AND "management". 70 unique publications were used. The findings are discussed under "Screening" and "Management" categories. Screening: Current cancer screening recommendations default to cis-gender protocols. However, long-term gender-affirming hormone therapy and loss to follow-up from the gender-specific specialties contribute to a higher risk for cancer development and possible delayed detection. The only known screening guidelines made specifically for this population are from the American College of Radiology for breast cancer. Management: Prior to undergoing Gender Affirmation Surgery (GAS), discussion should address cancer screening and management in the organs remaining in situ. Cancer treatment in this population requires consideration for chemotherapy, radiation, surgery and/or reconstruction. Modification of hormone therapy is decided on a case-by-case basis. The use of prophylactic vs aesthetic techniques in surgery is still debated. When assessing transgender individuals for GAS, a discussion on the future oncologic risk of the sex-specific organs remaining in situ is essential. Cancer management in this population requires a multidisciplinary approach while the care should be highly individualized with considerations to social, medical, surgical and gender affirming surgery related specifications. Special considerations have to be made during planning for GAS as surgery will alter the anatomy and may render the organ difficult to sample for screening purposes. A discussion with the patient regarding the oncologic risk of remaining organs is imperative prior to GAS. Other special considerations to screening such as the conscious or unconscious will to unassociated with their remaining organs is also a key point to address. We currently lack high quality studies pertinent to the cancer topic in the gender affirmation literature. Further research is required to ensure more comprehensive and individualized care for this population.

Expert consensus on newborn screening for spinal muscular atrophy (2023 edition)

Spinal muscular atrophy (SMA) is a common degenerative neurological disease characterized by progressive muscle weakness and atrophy. In recent years, disease-modifying therapies have emerged and changed the natural course of SMA, with pre-symptomatic diagnosis and treatment being superior to post symptom treatment. Therefore, in order to standardize and guide the current newborn screening work of SMA, we organized national experts from related fields across the country to reach the following consensus: the SMA newborn screening process and related issues, the SMA post-screening diagnosis process and related issues, and the disease management of screened and confirmed SMA newborns, etc.

Current Inpatient Screening Practices for Sexual History and STIs: An Opportunity to Seize.

The American Academy of Pediatrics recommends utilizing hospitalizations as an opportunity to provide sexual health screenings for adolescents. This study aimed to describe the current practice of sexual history documentation (SHxD) and sexually transmitted infection (STI) testing among adolescents admitted to a pediatric hospital medicine service. Retrospective cross-sectional study of adolescents (14-19 years old) admitted to the PHM service from 2017-2019 was performed at an academic children's health system. Patient (demographics, history of complex chronic condition, and insurance), hospitalization (length of stay, diagnosis, STI tests ordered/results), and physician (level of training and gender) characteristics were extracted for each encounter. A natural language processing algorithm identified the presence of SHxD. Univariate analysis and multivariable analysis were performed to detect factors associated with SHxD and STI screening. The prevalence of STIs was calculated for those who were tested. Out of 2242 encounters, SHxD and STI testing rates were 40.9% and 17.2%, respectively. Patient gender, race, lack of complex chronic condition, and resident involvement were predictive of SHxD and STI testing. SHxD increased the odds of STI testing significantly (OR 5.06, CI 3.90-6.58). Among those who were tested, the prevalence of STIs was highest for chlamydia (37/329, 11.2%). Overall, sexual health screening rates remain low in the hospital setting and future improvement initiatives are needed.

The Carrier Frequency of Two SMN1 Genes in Parents of Symptomatic Children with SMA and the Significance of SMN1 Exon 8 in Carriers.

Current carrier screening methods do not identify a proportion of carriers that may have children affected by spinal muscular atrophy (SMA). Additional genetic data is essential to inform accurate risk assessment and genetic counselling of SMA carriers. This study aims to quantify the various genotypes among parents of children with SMA. A retrospective cohort study was undertaken at Sydney Children's Hospital Network, the major SMA referral centre for New South Wales, Australia. Participants included children with genetically confirmed SMA born between 2005 and 2021. Data was collected on parent genotype inclusive of copy number of SMN1 exons 7 and 8. The number of SMN2 exon 7 copies were recorded for the affected children. Descriptive statistics were used to determine the proportion of carriers of 2+0 genotype classified as silent carriers. Chi-square test was used to correlate the association between parents with a heterozygous SMN1 exon 7 deletion and two copies of exon 8 and ≥3 SMN2 copy number in the proband. SMA carrier testing was performed in 118/154 (76.6%) parents, incorporating 59 probands with homozygous SMN1 deletions and one proband with compound heterozygote pathogenic variants. Among parents with a child with SMA, 7.6% had two copies of SMN1 exon 7. When only probands with a homozygous SMN1 exon 7 deletion were included, 6.9% of parents had two copies of SMN1 exon 7. An association was observed between heterozygous deletion of SMN1 exon 7 with two copies of exon 8 in a parent and ≥3 SMN2 copy number in the affected proband (p = 0.07). This study confirmed a small but substantial proportion of silent carriers not identified by conventional screening within an Australian context. Accordingly, the effectiveness of carrier screening for SMA is linked with genetic counselling to enable health literacy regarding high and low risk results and is complemented by new-born screening and maintaining clinical awareness for SMA. Gene conversion events may underpin the associations between parent carrier status and proband SMN2 copy number.

Haemovigilance and Trends of Transfusion Transmissible Viral Infections among Asymptomatic Population at Akatsi South Municipal in Volta Region of Ghana from 2014 to 2019

Background: The use of advance screening tools to prevent Transfusion Transmissible Infections (TTIs), is critical to Sustainable Development Goals (SDG.3.3). This study assessed the implications of using chromatographic Rapid Diagnostic Test (RDTs) kits, and dynamics on TTIs, including Human Immunodeficiency Virus (HIV) among blood donors at the Akatsi South Municipality in the Volta Region of Ghana. Methods: This was a haemovigilance study, designed to retrospectively evaluate secondary data on 2,588 blood donors in Akatsi South District Hospital from 2014 to 2019. The data was collected using data extraction log, quality controlled using double data entry mechanism, and managed electronically using Microsoft Visual Basics and STATA. TTIs’ trends were determined using frequentist and descriptive statistics, and 95% confidence intervals using the Clopper Pearson test. Results: Prevalence of TTIs was 8.0%. The prevalence of HIV as well as HBV and HCV, was 3.8%, 3.2% and 1.0% respectively. For female hosts, the prevalence was 7.4% (HIV), 4.2 % (HBV) and 1.6% (HCV). For Male-host, the rates were 3.1% (HIV), 3.5% (HBV) and 1.0% (HVC). Donors aged 15-19years were most infected at rates of 13.2% (HIV), 4.7% (HBV) and 1.9% (HCV). About 57(2.4%) and 3(1.2%) of 2380 blood donated were TTIs false negatives and false positives respectively. Conclusion: Generally, there was reductive trends in prevalence of named TTIs, including HIV at a rate of 30.3% across the period. However, the rate of new HIV infections was above the regional and national rates, and this has research and policy implications. In addition, the limitation of current screening tool to detect about 2.4% of named TTIs among the screened blood was a potential risk medium for transfusing unsafe blood. A relatively higher sensitive blood transfusion screening method is urgently needed to prevent the transfusion of HIV, HBV and HCV false negative blood in Akatsi Municipal Hospital.

A perspective on current therapeutic molecule screening methods against 'Candidatus Liberibacter asiaticus', the presumed causative agent of citrus Huanglongbing.

Huanglongbing (HLB), referred to as citrus greening disease, is a bacterial disease impacting citrus production worldwide and fatal in young trees and certain varieties. In some areas, the disease is devastating the citrus industry. A successful solution to HLB will be measured in economics: Citrus growers need treatments that improve tree health, fruit production, and most importantly economic yield. The profitability of citrus groves is the ultimate metric that truly matters when searching for solutions to HLB. Scientific approaches used in the laboratory, greenhouse, or field trials are critical to discovery of those solutions and to estimate the likelihood of success of a treatment aimed for commercialization. Researchers and the citrus industry use a number of proxy evaluations of potential HLB solutions and understanding the strengths and limitations of each assay as well as how best to compare different assays is critical for decision making to advance therapies into field trials and commercialization. This perspective aims to help the reader compare and understand the limitations of different proxy evaluation systems based on the treatment and evaluation under consideration. The researcher must determine the suitability of one or more of these metrics to identify treatments and predict the usefulness of these treatments in having an eventual impact on citrus production and HLB mitigation. As therapies advance to field trials in the next few years, a re-evaluation of these metrics will be useful to guide future research efforts on strategies to mitigate HLB and vascular bacterial pathogens in other perennial crops.

Microbiome-derived cobalamin and succinyl-CoA as biomarkers for improved screening of anal cancer.

Human papillomavirus can cause preinvasive, high-grade squamous intraepithelial lesions (HSILs) as precursors to cancer in the anogenital area, and the microbiome is suggested to be a contributing factor. Men who have sex with men (MSM) living with human immunodeficiency virus (HIV) have a high risk of anal cancer, but current screening strategies for HSIL detection lack specificity. Here, we investigated the anal microbiome to improve HSIL screening. We enrolled participants living with HIV, divided into a discovery (n = 167) and validation cohort (n = 46), and who were predominantly (93.9%) cisgender MSM undergoing HSIL screening with high-resolution anoscopy and anal biopsies. We identified no microbiome composition signatures associated with HSILs, but elevated levels of microbiome-encoded proteins producing succinyl coenzyme A and cobalamin were significantly associated with HSILs in both cohorts. Measurement of these candidate biomarkers alone in anal cytobrushes outperformed anal cytology as a diagnostic indicator for HSILs, increasing the sensitivity from 91.2% to 96.6%, the specificity from 34.1% to 81.8%, and reclassifying 82% of false-positive results as true negatives. We propose that these two microbiome-derived biomarkers may improve the current strategy of anal cancer screening.

Investigation of potential prognostic biomarkers for colorectal cancer

IntroductionColorectal cancer (CRC) is the third leading cause of cancer-related death. Since CRC is largely asymptomatic until the alert features develop to an advanced stage, implementation of a screening program is important to reduce cancer morbidity and mortality. Current screening methods have significant limitations.Material and methodsCRC-related microarray datasets were collected from the GEO database and differentially expressed genes (DEGs) were identified. Next, Venn analysis, functional enrichment analysis, protein interaction network (PPI) analysis, and survival analysis were performed.ResultsA total of 5267 and 4233 DEGs were identified in two datasets (GSE20916, GSE33133). The intersection of up-regulated genes in the two datasets was obtained by Venn Analysis as 1058 DEGs. Among the 1058 genes, 992 genes with survival and clinical information in TCGA were screened. Eleven DEGs were identified as potential prognostic markers. Model results show that the time period with the most obvious prognostic effect is 5 years, and the AUC value is the highest. ROC curve results are consistent with the model results of the survival analysis. The survival curve showed that LRRC8A, PCAT6, PLA2G15, SRD5A1, T1GD1 may be oncogenes, and DSN1, ERI1, EIT1, GLMN, MAPKAPK, NOP14 may be tumor suppressor genes.ConclusionsThis study discovers novel prognostic markers through Cox regression and survival analysis, and provides a theoretical basis for the treatment of CRC.

Mortality Benefit of a Blood-Based Biomarker Panel for Lung Cancer on the Basis of the Prostate, Lung, Colorectal, and Ovarian Cohort.

To investigate the utility of integrating a panel of circulating protein biomarkers in combination with a risk model on the basis of subject characteristics to identify individuals at high risk of harboring a lethal lung cancer. Data from an established logistic regression model that combines four-marker protein panel (4MP) together with the Prostate, Lung, Colorectal, and Ovarian (PLCO) risk model (PLCOm2012) assayed in prediagnostic sera from 552 lung cancer cases and 2,193 noncases from the PLCO cohort were used in this study. Of the 552 lung cancer cases, 387 (70%) died of lung cancer. Cumulative incidence of lung cancer death and subdistributional and cause-specific hazard ratios (HRs) were calculated on the basis of 4MP + PLCOm2012 risk scores at a predefined 1.0% and 1.7% 6-year risk thresholds, which correspond to the current and former US Preventive Services Task Force screening criteria, respectively. When considering cases diagnosed within 1 year of blood draw and all noncases, the area under receiver operation characteristics curve estimate of the 4MP + PLCOm2012 model for risk prediction of lung cancer death was 0.88 (95% CI, 0.86 to 0.90). The cumulative incidence of lung cancer death was statistically significantly higher in individuals with 4MP + PLCOm2012 scores above the 1.0% 6-year risk threshold (modified χ2, 166.27; P < .0001). Corresponding subdistributional and lung cancer death-specific HRs for test-positive cases were 9.88 (95% CI, 6.44 to 15.18) and 10.65 (95% CI, 6.93 to 16.37), respectively. The blood-based biomarker panel in combination with PLCOm2012 identifies individuals at high risk of a lethal lung cancer.

Flexible transition probability model for assessing cost-effectiveness of breast cancer screening extension to include women aged 45-49 and 70-74.

Breast cancer is the most common cancer among Western women. Fortunately, organized screening has reduced breast cancer mortality. New recommendation by the European Union suggests extending screening with mammography from 50-69-year-old women to 45-74-year-old women. However, before extending screening to new age groups, it's essential to carefully consider the benefits and costs locally as circumstances vary between different regions and/or countries. We propose a new approach to assess cost-effectiveness of breast cancer screening for a long-ongoing program with incomplete historical screening data. The new model is called flexible stage distribution model. It is based on estimating the breast cancer incidence and stage distributions of breast cancer cases under different screening strategies. The model parameters, for each considered age group, include incidence rates under screening/non-screening, probability distribution among different stages, survival by stages, and treatment costs. Out of these parameters, we use the available data to estimate survival rates and treatment costs, while the modelling is done for incidence rates and stage distributions under screening policies for which the data is not available. In the model, an ongoing screening strategy may be used as a baseline and other screening strategies may be incorporated by changes in the incidence rates. The model is flexible, as it enables to apply different approaches for estimating the altered stage distributions. We apply the proposed flexible stage distribution model for assessing incremental cost of extending the current biennial breast cancer screening to younger and older target ages in Finland.

Characterization of the Human Blood Virome in Iranian Multiple Transfused Patients.

Blood transfusion safety is an essential element of public health. Current blood screening strategies rely on targeted techniques that could miss unknown or unexpected pathogens. Recent studies have demonstrated the presence of a viral community (virobiota/virome) in the blood of healthy individuals. Here, we characterized the blood virome in patients frequently exposed to blood transfusion by using Illumina metagenomic sequencing. The virome of these patients was compared to viruses present in healthy blood donors. A total number of 155 beta-thalassemia, 149 hemodialysis, and 100 healthy blood donors were pooled with five samples per pool. Members of the Anelloviridae and Flaviviridae family were most frequently observed. Interestingly, samples of healthy blood donors harbored traces of potentially pathogenic viruses, including adeno-, rota-, and Merkel cell polyomavirus. Viruses of the Anelloviridae family were most abundant in the blood of hemodialysis patients and displayed a higher anellovirus richness. Pegiviruses (Flaviviridae) were only observed in patient populations. An overall trend of higher eukaryotic read abundance in both patient groups was observed. This might be associated with increased exposure through blood transfusion. Overall, the findings in this study demonstrated the presence of various viruses in the blood of Iranian multiple-transfused patients and healthy blood donors.

P-784 First trimester screening for preterm preeclampsia after ART: high risk, high gain?

Abstract Study question What is the preterm preeclampsia (pPE) incidence in selected high-risk ART patient populations when applying a first trimester screening approach to recommend prevention via aspirin? Summary answer One in five high-risk ART patients had a calculated risk &amp;gt;1/100 and despite aspirin prophylaxis still 22.2% of them developed pPE. What is known already Preeclampsia (PE) is an obstetrical complication defined by new-onset hypertension after 20 weeks’ gestation with proteinuria, end-organ (including placental) dysfunction or both. First trimester pPE screening is gaining ground in prenatal care since a study on approximately 60.000 singleton pregnancies reported an algorithm able to detect 76% of pPE and 38% of term PE (tPE). A RCT showed that aspirin, prescribed upon positive screening, led to an effective (62%) reduction of pPE incidence. This screening/prevention strategy has not been validated in the context of ART pregnancies, while some ART patient groups are known to be at higher risk for PE. Study design, size, duration This is a retrospective, single-center, observational cohort study, including 242 patients between 18 and 48 years old, pregnant after ART and considered at higher risk of PE because of one of the following characteristics: diagnosed with polycystic ovary syndrome (PCOS), being an oocyte recipient (OR) or pregnant from a frozen embryo transfer in an artificially prepared cycle (HRT-FET). Patients were included from May 2021 until July 2022. Participants/materials, setting, methods Screening was systematically offered between 11-14 weeks’ gestation, according to the Fetal Medicine Foundation (FMF) algorithm including maternal factors, mean arterial pressure, uterine arteries pulsatility index and serum placental growth factor. If the risk of developing PE was &amp;gt;1/100, administration of 160mg aspirin was started until 36 weeks’ gestation. Primary outcome was the incidence of pPE(&amp;lt;37 weeks). Secondary outcomes were the incidence of tPE(≥37 weeks) and the incidence of positive first trimester screening (risk &amp;gt;1/100). Main results and the role of chance A total of 242 unique patients were screened: 58 oocyte recipients (ORs), 89 PCOS and 95 HRT-FET patients (the latter having no PCOS and using autologous oocytes). The overall positive screening incidence was 21.9%(53/242), with the highest positive screening rate in ORs (27.6%, 16/58). In PCOS and HRT-FET patients, we observed a positive screening test in 20.2%(18/89) and 20.0%(19/95), respectively. For comparison, the positive screening rate reported for the general population was 10.5%. Despite the prophylactic aspirin regimen started upon positive screening, in the current study an overall pPE incidence of 22.6%(12/53) was observed while the reported pPE incidence in the general population in this setting was only 1.6%. More specifically, 31.2%(5/16) ORs with positive screening developed pPE although they used aspirin. For PCOS and HRT-FET patients, this was 11.1%(2/18) and 21.1% (4/19), respectively. tPE occurred in 7.5%(4/53) of women with positive screening and aspirin intake (1/16 in ORs, 1/18 in PCOS patients and 2/19 following HRT-FET). For comparison, in the general population this was 6.7%. Following a negative first trimester screening test, 2.1%(4/189) of patients developed pPE and 3.7%(7/189) tPE. In a non-selected population, these incidences have been reported to be 0.2% and 1.1%, respectively. Limitations, reasons for caution This study is limited by its retrospective study design, small sample size and observational nature. Nevertheless, it is of major importance to communicate the strikingly high pPE incidences in specific subtypes of ART patients despite first trimester screening and aspirin prophylaxis. Wider implications of the findings Our findings suggest that current screening algorithms are not optimized for women pregnant following ART. In pregnancies from oocyte donation, aspirin might be less effective. Future research should aim at finetuning PE screening methods specifically for ART patients and differential mechanisms of PE origin need to be further investigated. Trial registration number Not applicable

1321-P: Screening for Liver Fibrosis in Diabetes—Assessing the Performance of Current Recommendations in a Large Unselected Population

American Diabetes Association’s Standard of Care 2023 recommended screening patients with T2D for significant liver fibrosis with FIB-4 and transient elastography (TE). However, the evidence supporting this approach is controversial. The aim of this study was to assess the use of FIB-4, and its correlation with TE, in an unselected population of patients with diabetes. Adult patients from NHANES 2017-2020 with complete data on FIB-4 and TE were included. Diabetes was defined based on FPG, A1c or prior history. Patients with secondary causes of liver steatosis were excluded. NAFLD was defined as a controlled attenuation parameter ≥274 dB/m, while clinically significant and advanced liver fibrosis were defined as TE ≥9.6 and ≥12 kPa, respectively. Among 1193 patients with diabetes (Age: 61 ± 13; BMI: 32.6 ± 7.3 kg/m2; A1c: 7.4 ± 1.7%), the prevalence of NAFLD, clinically significant liver fibrosis, and advanced fibrosis were 68%, 15% and 8%, respectively. These were significantly higher than in patients without diabetes even after stratifying for BMI (all p&amp;lt;0.001). Liver fibrosis worsened with increasing insulin resistance (HOMA-IR), but were not associated with A1c levels. FIB-4 performed poorly to predict significant or advanced liver fibrosis in diabetes (AUC: 0.59 [0.54-0.64] and AUC: 0.63 [0.56-0.69], respectively). Moreover, it performed numerically worse than plasma AST alone (AUC: 0.63, p=0.10 and AUC: 0.68, p=0.10, respectively). Among patients with significant and advanced fibrosis based on TE, FIB-4 was &amp;lt;1.30 (suggested cut-off for screening) in 51% and 47% of patients (i.e., false negatives), suggesting a significant disagreement between these tests. Patients with diabetes are at high risk of liver disease, and therefore, screening for liver fibrosis is warranted. However, our results suggest that current screening strategies based on FIB-4 and TE may not be adequate, as they may miss a significant number of patients with advanced fibrosis. Disclosure F.Bril: None. M.Gray: Advisory Panel; Takeda Pharmaceutical Co., Ltd., Theratechnologies, Consultant; Novo Nordisk.