Determinant Of Favorable Outcome Research Articles

Identification and external validation of clinical-molecular features to predict benefit from oxaliplatin reintroduction/rechallenge in patients with refractory metastatic colorectal cancer (mCRC).

153 Background: Oxaliplatin is a backbone cytotoxic treatment for mCRC patients, particularly in the front-line setting. In the refractory disease, current treatment options are scarce and with limited efficacy. Several retrospective studies have explored the efficacy of oxaliplatin reintroduction/rechallenge (OxRe) in this scenario. However, more evidence is still needed to determine which patients do benefit from this treatment strategy. Methods: The discovery cohort includes all patients treated with oxaliplatin in a third- or fourth-line setting at VHIO between 2015 and 2021 (N = 102). Results were externally validated in a real-world cohort of patients treated at community oncology practices from Oncoclínicas Group in Brazil (N = 157). We analyzed the impact of clinical-molecular features in uni- and multivariable prognostic models in terms of median progression free survival (mPFS) (discovery cohort) and median time to treatment discontinuation (mTTD) (validation cohort). For both cohorts separately, data was extracted from EHRs in structured formats (demographics, tumor characteristics, pharmacy records) and combined with elements from unstructured sources (physician notes on progression and survival status) using technology-based abstraction techniques. Results: In the discovery cohort, 102 out of 735 mCRC patients (13,9%) were eligible. Median oxaliplatin-free interval (from Oxl stop to OxRe) was 17 months (CI95% 13.0-23.2). In OxRe setting, mPFS was 4.0 months (CI95% 3.29-5.03). In PFS multivariate analysis, determinants of favorable outcome were left tumor location (p = 0.01), oxaliplatin-free interval (p = 0.03), administration of Bev in refractory setting (p = 0.001), and not receiving Bev in first-line treatment (p = 0.008). Overall, 27% of all patients had a mPFS > 6 months with OxRe. In the validation cohort, out of 4,317 patients with mCRC, 157 (4%) were treated with OxRe. Median oxaliplatin-free interval was 15 months. Median time to treatment discontinuation (mTTD) of the OxRe was 3.4 months (CI95% 2.8-4.2). In multivariable model, the only independent prognostic factor was addition of Bev to OxRe (p = 0.036). Interestingly, 31% of all patients had mTTD > 6 months, largely enriched (65%) in patients with first Bev exposure at the time of OxRe. Conclusions: This study suggests that in refractory mCRC patients re-exposed to oxaliplatin-based chemotherapy, the addition of Bev is associated with improved outcomes. One-third of the patients are long-term responders (PFS/TTD > 6 months), reinforcing the value of this strategy in selected populations and the relevance of anti-angiogenic agents in refractory mCRC.

Magnitude and determinants of treatment outcome among surgically treated patients with intestinal obstruction at Public Hospitals of Wolayita Zone, Southern Ethiopia: a cross sectional study, 2021

BackgroundProcedures to treat intestinal obstruction range from minimally invasive laparoscopic surgery to more complicated open surgical procedures. It may end with high morbidity and mortality because of different reasons. It is very important to know about the determinants of favorable outcome of surgical management for intestinal obstruction however, little is known about this problem at public hospitals of Southern Ethiopia.MethodsFacility based cross sectional study was conducted. A total of 230 medical records which fulfill the inclusion criteria were used for this study. Variables with p value of less than 0.25 in the bivariate analysis were entered in multivariable logistic regression to control confounding. Finally, odds ratio with 95% confidence interval was used to identify variables which were significantly associated with dependent variable.ResultsAccording to this study the magnitude of favorable surgical management outcome of intestinal obstruction was 177(77.0%) [95% CI, 71.4, 82.4]. Having small bowel obstruction (AOR = 2.49) [95% CI 1.91, 5.12], having simple bowel obstruction (AOR = 4.32) [95% CI, 2.00, 9.35], early presentation of patients (AOR = 4.44) [95% CI, 1.99, 9.92] and intraoperative procedure other than resection and anastomosis was performed (AOR = 0.45) [95% CI, 0.21, 0.96] were significantly associated with favorable outcome among surgically treated patients.ConclusionThe overall magnitude of favorable surgical management outcome of intestinal obstruction was moderate compared to other study. Having small bowel obstruction, having simple bowel obstruction, other procedure other than resection and anastomosis done, and early presentation of patients were significant predictors. Physicians should diagnose intestinal obstruction early and appropriate interventions should be taken on time before the complication happened. On time consultation and decision at the hospital setting is also recommended.

P2615Ages are not a determinant of favorable outcome of balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension

P2615Ages are not a determinant of favorable outcome of balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension

Tigecycline-Based Front-Line Antibiotic Therapy Significantly Decreases Mortality Among Patients with Neutropenic Enterocolitis Following Cytarabine-Containing Chemotherapy for the Remission Induction of Acute Myeloid Leukemia

BackgroundNeutropenic enterocolitis (NEC) is an abdominal infection reported in patients with acute myeloid leukemia (AML) following chemotherapy, especially cytarabine. Specific data regarding the impact of different cytarabine schedules and antibacterial regimens for NEC are sparse.AimsThe aim of this study was to provide an update on therapeutic interventions of NEC. Predictors of mortality and determinants of favorable outcome at 30 days after NEC onset were considered, and finally we focused on the optimal antibiotic strategy for the preemptive therapy of NECMethodsNEC episodes were retrospectively pinpointed among 440 patients with newly diagnosed AML hospitalized in our institution, from 1 January 2002 to 31 December 2012, for receiving chemotherapy protocols with cytarabine. Two subgroups, survivors versus non-survivors, were compared to identify the predictors of outcome within 30-days of NEC onset. Finally, an optimal antibiotic strategy for front-line NEC treatment was suggested.Patients with severe neutropenia and clinical signs suggestive of NEC, i.e. fever (axillary temperature ³38¡C), diarrhea (>1 stool daily) and/or abdominal pain, were under strict ultrasonographic monitoring. Patients positive at US examination for pathologic bowel wall thickening (>4 mm in transversal scans for at least 30 mm length) were diagnosed with NEC, according to standardized criteria.The following variables were selected for the statistical analysis: antileukemic protocols [containing standard-dose (100 mg/m2 daily for at least 7 days), intermediate-dose (200 mg/m2 daily for at least 7 days), and high-dose (2000 to 6000 mg/m2 daily for at least 4 days) cytarabine], ultrasonographic features, microbiological findings, antibacterial therapy (front-line antibiotic treatments of febrile neutropenia that spared tigecycline, and the number and type of antibiotics definitively used after NEC diagnosis), adjunct therapeutic modalities (systemic antifungal therapy, G-CSF, bowel rest and total parenteral nutrition), and severe neutropenia resolution.ResultsNEC was documented in 100 (23.8%) of analyzed patients: 42.5% had received high-dose cytarabine while 19% and 15% intermediate-dose and standard-dose cytarabine, respectively (P<0.001). The 30-day NEC attributable mortality was 23%.In univariate analysis, patients in the non-survivor subgroup were more likely to have received induction chemotherapy courses based on high-dose cytarabine (P< 0.001) and NEC treatment with tigecycline-sparing ²2-antibiotic regimens. In fact, the 23 patients who died included 13 of the 37 patients (35.1%) whose antibacterial regimens consisted of 2-antibiotic combinations and 10 of the 63 patients (15.8%) who were on 3-antibiotic combination regimens (P= 0.027). The only multidrug regimen that was significantly more common in the survivor subgroup (P= 0.036) was the combination of tigecycline, meropenem and daptomycin.In multivariate analysis, high-dose cytarabine-containing chemotherapy was the independent predictor of poor outcome (OR: 0.089; 95%CI: 0.024-0.329; P<0.001), whereas NEC therapy with a combination of three specific antibiotics (tigecycline, meropenem and daptomycin) was associated with a favorable outcome (OR: 5.096; 95%CI: 1.516-17.131; P=0.008).ConclusionChemotherapy schedules with vigorous dosages of cytarabine for AML remission are associated with a high rate of NEC incidence and attributable mortality. Prompt initiation of combined therapy with regimens of different antibiotic classes which have synergistic activity against complicated intra-abdominal infections, specifically those including tigecycline, may be particularly effective in improving 30-day survival rate after NEC onset. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Oral Feeding in Necrotizing Pancreatitis

Background: Restoration of gastrointestinal function is a crucial determinant of favorable outcome in severe acute pancreatitis (SAP). The purpose of this study was to retrospectively review our experience with early oral feeding in patients with the necrotizing form of SAP. Over the last 10 years, we have routinely gradually increased oral feeds in order to restore gastrointestinal function.Methods: Early low volume oral (ELVO) feeds containing 248–330 kcal/daily were routinely provided for all patients to help stimulate gastrointestinal function. Patients who received ELVO feeding within 72 hours of admission were allocated to Group I; those who received ELVO feeds after 72 hours were allocated to Group II. The volume and calories of the feed, magnitude of systemic inflammation, levels of C-reactive protein (CRP) and lipase, incidence of organ dysfunction, main outcomes, and complications were analyzed.Results: In total, 129 patients received ELVO feedings. The mean CRP level on day 7 was 160 ± 77.6 mg/l in Group I compared to 200.2 ± 103.2 mg/l in Group II, p = 0.043. Normalization of CRP below 100 mg/l was observed on day 14 in both groups. The rate of infection and the need for surgical intervention (46.8% vs. 26%) were significantly higher in Group II (p = 0.026). Group II also had longer ICU/hospital stays (p = 0.039/p = 0.002). Overall mortality was 10%. Conclusions: ELVO feeding provides physiologic stimulation and promotes recovery of bowel function, preparing the gastrointestinal tract for low-fat hospital food in patients with necrotizing SAP. The majority of patients required no additional nutritional support.

Optimizing Therapy for Candida Infections

The problem of invasive candidiasis among ICU patients is an increasing and evolving one. Despite advances in supportive care, increasing numbers of critically ill and vulnerable patients are susceptible to infection, and the clinical consequences for those who do develop invasive candidiasis remain poor. Evolving epidemiological trends, particularly a relative increase in the incidence of fluconazole-resistant Candida spp., have further complicated management. The recent availability of antifungal agents, such as voriconazole, the echinocandins, and lipid-associated amphotericin B preparations, with improved safety profiles, extended spectra, and proven clinical efficacies, offers new therapeutic options. However, optimizing therapy requires the consideration of numerous factors: the differing pharmacological properties of these agents, cost, the clinical status and progress of the patient, estimates of the likelihood of resistance, and microbiological data as they become available. Because early institution of antifungal therapy appears an important determinant of favorable outcome, accurate early microbiological and clinical markers of invasive candidiasis to guide early antifungal interventions are desperately needed and remain an area of active investigation.