Early Predictive Factors Research Articles

Nuclear cataract as an early predictive factor for recalcitrant juvenile idiopathic arthritis–associated uveitis

To analyze factors predictive of having treatment-resistant uveitis in patients with juvenile idiopathic arthritis (JIA)-associated uveitis. The medical records of patients diagnosed with JIA-associated uveitis treated at a single tertiary referral center from October 2005 to March 2013 were reviewed retrospectively. The main outcome measures were demographic characteristics, ocular comorbidity, clinical course, treatments, and baseline risk factors associated with poor response to first-line therapies. A total of 96 patients (175 eyes) were included. Of these, 58 patients (108 eyes) required biologic disease-modifying antirheumatic drugs or alkylating agents for their uveitis during follow-up (recalcitrant group), and 38 patients (67 eyes) did not (nonrecalcitrant group). Eyes of the recalcitrant group tended to have a higher incidence of cataract at baseline (49%; P<0.0001). In the nonrecalcitrant group, the most frequent complications were cataract (20.9%) and secondary glaucoma (20.9%). The mean number of flares in the recalcitrant group was significantly reduced from 3.7/eye/year prior to cataract surgery to 1.6/eye/year after (P<0.0001). Nuclear cataract was found to be an independent predictor for a severe course of JIA-associated uveitis. Any other type of cataract, posterior synechiae, male sex, or active uveitis at baseline were not found to be independently associated with recalcitrant uveitis. Nuclear cataract at baseline evaluation is a risk factor for poor response to first-line therapies in JIA-associated uveitis patients.

0202: Predictive factors of left ventricular recovery in acute heart failure revealing reduced left ventricular ejection fraction

Evaluate the factors presents at diagnosis associated to left ventricular recovery in acute heart failure (AHF) revealing reduced left ventricular ejection fraction (LVEF). A lot of paperwork have studied the left ventricular evolution in chronic heart failure but not in AHF and indistinctly of LVEF. We don’t know the predictive factors of left ventricular recovery in a specific population of acute heart failure revealing reduced LVEF. We conducted a prospective and observational longitudinal study with retrospective data collection based on a cohort of patients with acute heart failure revealing reduced LVEF (≤45%), in the emergency department and cardiac intensive care unit (ED and CCIU) of the University Hospital of Lille, between November 1st, 2011 and May 31st, 2013. The primary endpoint was the improvement of LVEF or left ventricular reverse remodeling. Among the 111 patients included, 57% of patients benefited from an improvement of LVEF and 62% from a reverse remodeling in the 51% of patients with a dilated left ventricle. The improvement of LVEF was associated in univariate analysis to non ischaemic etiology (p=0.002) and greater utilization of betablockers (p=0.076) and angiotensin-converting enzyme (p=0.0337) and in multivariate analysis, independtly to younger patients (p=0.0325) and presentation by cardiogenic shock (p=0.0484). The same predictive factors were found for reverse remodeling. The knowledge of the prevalence and the early predictive factors of the left ventricular recovery can be useful to guide the follow-up and non-pharmacological management of heart failure with reduced LVEF.

Exclusive breast feeding in early infancy reduces the risk of inpatient admission for diarrhea and suspected pneumonia in rural Vietnam: a prospective cohort study

BackgroundAcute respiratory infections and diarrhea remain the leading causes of infant morbidity and mortality, with a high burden of both pneunomia and diarrhea in South-East Asia. The aim of the study was to determine antenatal and early infant predictive factors for severe morbidity episodes during the first 6 months of life in Ha Nam province, Vietnam.MethodsA prospective cohort study of 1049 infants, born to women who had previously participated in a cluster randomized controlled trial of antenatal micronutrient supplementation in rural Vietnam, was undertaken between 28th September 2010 and 8th Jan 2012. Infants were followed until 6 months of age, and the outcome measure was inpatient admission for suspected pneumonia or diarrheal illness during the first 6 months of life. Risk factors were assessed using univariable logistic regression and multiple logistic regression.ResultsOf the 1049 infants seen at 6 months of age, 8.8 % required inpatient admission for suspected pneumonia and 4 % of infants required inpatient admission for diarrheal illness. One third of infants (32.8 %) were exclusively breast fed at 6 weeks of age. Exclusive breast feeding at 6 weeks of age significantly reduced the odds of inpatient admission for suspected pneumomia (Odds Ratio (OR) 0.39, 95 % Confidence Interval (CI) 0.20 to 0.75) and diarrheal illness (OR 0.37, 95 % CI 0.15 to 0.88).ConclusionsExclusive breast feeding in early infancy reduces the risk of severe illness from diarrhea and suspected pneumonia. Public health programs to reduce the burden of inpatient admission from diarrheal and respiratory illness in rural Vietnam should address barriers to exclusive breast feeding.

Early prediction of urinary tract infection in neonates with hyperbilirubinemia.

Introduction: Hyperbilirubinemia is a common manifestation of infectious disorders during the neonatal period. Urinary tract infection (UTI) is one of the serious bacterial infections with hyperbilirubinemia among newborn infants. Objectives: The aim of this study was to identify the early predictive risk factors of UTI in neonates with hyperbilirubinemia, to prevent its long-term complications. Patients and Methods: A total of 95 neonatal hyperbilirubinemia were evaluated in 2 groups with (n = 40) and without UTI (n = 55). Results: Mean age at diagnosis of UTI was 16.37 ± 8.86 days. Hyperbilirubinemia was detected in 70% of patients during the first week of life. There was a significant difference regarding the age at admission, duration of hyperbilirubinemia, serum bilirubin and creatinine, white blood cells (WBC) , and also Hgb levels between the 2 groups in univariate analysis. However, prolonged jaundice (OR = 10.3, P = 0.001) and serum bilirubin concentration (OR = 5.15, P = 0.001) were statistically associated with a positive urine culture in multivariate analysis. Conclusion: Screening of UTI is recommended in neonates with prolonged unexplained jaundice, leukocytosis, and increased serum creatinine.

Biliary Cast Syndrome: Hepatic Artery Resistance Index, Pathological Changes, Morphology and Endoscopic Therapy.

Background:Biliary cast syndrome (BCS) was a postoperative complication of orthotopic liver transplantation (OLT), and the reason for BSC was considered to relate with ischemic type biliary lesions. This study aimed to evaluate the relationship between BCS following OLT and the hepatic artery resistance index (HARI), and to observe pathological changes and morphology of biliary casts.Methods:Totally, 18 patients were diagnosed with BCS by cholangiography following OLT using choledochoscope or endoscopic retrograde cholangiopancreatography. In addition, 36 patients who did not present with BCS in the corresponding period had detectable postoperative HARI on weeks 1, 2, 3 shown by color Doppler flow imaging. The compositions of biliary casts were analyzed by pathological examination and scanning electron microscopy.Results:HARI values of the BCS group were significantly decreased as compared with the non-BCS group on postoperative weeks 2 and 3 (P < 0.05). Odds ratio (OR) analysis of HARI 1, HARI 2, HARI 3 following the operation was >1 (OR = 1.300; 1.223; and 1.889, respectively). The OR of HARI 3 was statistically significant (OR = 1.889; 95% confidence interval = 1.166–7.490; P = 0.024). The compositions of biliary casts were different when bile duct stones were present. Furthermore, vascular epithelial cells were found by pathological examination in biliary casts.Conclusions:HARI may possibly serve as an independent risk factor and early predictive factor of BCS. Components and formation of biliary casts and bile duct stones are different.

Transient and permanent hypocalcemia after total thyroidectomy: Early predictive factors and long-term follow-up results

Post-thyroidectomy hypocalcemia is among the most common complications of total thyroidectomy. The purpose of this study was to evaluate early predictive factors and long-term changes in intact parathyroid hormone (iPTH) levels in patients with transient and permanent hypocalcemia after total thyroidectomy. A total of 349 consecutive patients who underwent total thyroidectomy with or without neck dissection between 2009 and 2011 were reviewed. PTH, total calcium (Ca), and ionized Ca (iCa) levels were evaluated at 1 hour, and 1, 3, 5, and 7 days, and 1, 3, 6, and 12 months postoperatively. Biochemical profiles at 1 hour after total thyroidectomy in patients with transient and permanent hypocalcemia were compared. Patients with postoperative hypocalcemia were followed for 12 months. Lesser preoperative serum levels of Ca and more extensive surgery were significantly associated with postoperative hypocalcemia (P < .05). The absolute level and relative decline (%) in iPTH at 1 hour were the most reliable predictors of postoperative hypocalcemia according to the receiver operating characteristics curve, with a threshold of 10.42 pg/mL and 70%. Sensitivity and specificity of the predictors were 83.4% (95% CI, 76.4-89.1), 100% (95% CI, 84.6-100.0), 84.1 (95% CI, 77.2-89.7), and 95.5% (95% CI, 77.2-99.9), respectively. Parathyroid function recovered in the first month after total thyroidectomy in 78 of 99 patients (79%) with transient hypocalcemia. However, 46 of 61 patients (74%) with a subnormal iPTH level at 3 months after surgery had permanent hypocalcemia. Mean postoperative PTH level and the mean relative decline in PTH measured 1 hour postoperatively were the most reliable predictors of postoperative or permanent hypocalcemia.

Early Anatomical Injury Patterns Predict Epilepsy in Head Cooled Neonates With Hypoxic-Ischemic Encephalopathy

BackgroundOur aim was to determine whether early anatomical injury patterns on magnetic resonance imaging-correlate with the development of postneonatal epilepsy in infants treated with selective head cooling for hypoxic-ischemic encephalopathy. MethodsWe retrospectively analyzed infants ≥35 weeks' gestation born between 2008 and 2013 and followed for at least one year at Northwestern University. All had brain magnetic resonance imaging scans at days 4-5 and electroencephalographs during rewarming and at 3 to 6 months of age. ResultsOutcome was favorable for our cohort of 73 individuals with a mean follow-up of 41 (±7) months. The majority (66%) survived with no seizure recurrence, whereas 13 (18%) developed postneonatal epilepsy, including eight who had infantile spasms. Twelve infants (16%) died. The most common magnetic resonance imaging pattern was diffuse brain injury involving both cortical and subcortical gray matter (26/73, 35%), followed by cortical and subcortical white matter injury (18/73, 25%) and normal magnetic resonance imaging (16/73, 22%). In 13 infants (18%), the brainstem was involved in addition to cortical and subcortical gray matter; nine died and all four surviving infants developed infantile spasms. All 18 infants with cortical and subcortical white matter injury survived and none developed postneonatal epilepsy. The risk of postneonatal epilepsy was associated with injury involving subcortical regions (basal ganglia, thalamus ± brainstem) (12/39 versus 1/34, P < 0.003). ConclusionsBrainstem injury was highly predictive of infantile spasms, whereas cortical injury alone predicted low risk for short-term postneonatal epilepsy. Location of anatomical injury on magnetic resonance imaging can be an early predictive factor for development of infantile spasms and inform prognostic decisions in newborns treated with selective head cooling for hypoxic-ischemic encephalopathy.

Validation of 1-year predictive score of long-term response to interferon-β in everyday clinical practice multiple sclerosis patients.

The Rio score (RS) and the modified Rio score (MRS) are two scoring systems that can identify the early predictive factors of disability progression in relapsing-remitting multiple sclerosis (RRMS) patients treated with interferon-β (IFN-β). The objective of the study was to validate the usefulness of the RS and MRS in a large cohort of multiple sclerosis patients treated with IFN-β in daily clinical practice. The analysis included a cohort of RRMS patients treated with different formulations of IFN-β for at least 1 year. The RS and MRS were used to classify the patients after 1 year of treatment. Multivariate analysis was performed to identify predictive variables of suboptimal response at 5 years, defined as Expanded Disability Status Scale confirmed progression or switching to a second-line therapy. Sixty-nine of 416 included patients were considered as suboptimal responders at 5-year evaluation. The possible score range was 0-3. A higher risk of suboptimal response was found for RS and MRS in the presence of ≥2 scores (hazard ratio 3.0, P = 0.002, and hazard ratio 5.0, P < 0.0001, respectively). Our study confirmed, in a daily clinical setting, that MRS had a better specificity and accuracy than RS in identifying the patients who will have a poor response to long-term IFN-β treatment.

Effects of Herceptin on circulating tumor cells in HER2 positive early breast cancer.

The objective of this study was to determine the changes in peripheral blood circulating tumor cells in HER2-positive early breast cancer before and after Herceptin therapy, and to explore the effects of the HER2 gene and Herceptin on circulating tumor cells. CK19 mRNA expression in peripheral blood was evaluated by qRT-PCR as an index of circulating tumor cells in 15 cases of HER-2-positive breast cancer and 18 cases of HER2-negative breast cancer before, and after chemotherapy as well. Ten cases of HER2-positive breast cancer continued on Herceptin therapy for 3 months after chemotherapy, and their peripheral blood was again drawn and assayed for CK-19 mRNA expression. Preoperatively, all cases of HER2-positive cancer were positive for CK19 mRNA in peripheral blood, but 6 cases of HER2-negative breast cancer were positive (33.3%), where there was a substantial difference between the two groups. After 6 cycles of adjuvant chemotherapy, CK19 positive rates in cases of HER2-positive and -negative breast cancer reduced by 93.3 and 11.1%, respectively, with a significant difference still existing. After 3 months of Herceptin therapy, expression of CK19 mRNA declined considerably in 10 cases of HER2 positive breast cancer (113.66 ± 88.65 vs 63.35 ± 49.27, P = 0.025). HER-2 gene expression closely correlated with circulating tumor cells in peripheral blood of early breast cancer patients. Moreover, Herceptin, a monoclonal antibody for HER2, can reduce the number of circulating tumor cells, which can be an early predictive factor for Herceptin therapy effectiveness against breast cancer.

Development of a mortality prediction formula due to sepsis/severe sepsis in a medical intensive care unit.

Background:Although sepsis is one of the leading causes of mortality in hospitalized patients, information regarding early predictive factors for mortality and morbidity is limited.Materials and Methods:Patients fulfilling the Infectious Disease Society of America criteria of sepsis within the medical intensive care unit (ICU) were included over two years. Apart from baseline hematological, biochemical, and metabolic parameters, Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II and III (SAPS II and SAPS III), and Sequential Organ Function Assessment (SOFA) scores were calculated on day 1 of admission. Patients were followed till death or discharge from the ICU.Results:One hundred patients were enrolled over two years (54% males). The overall mortality was 53%, (69.5% in females, 38.8% in males (P < 0.01). Mortality was 65.7%, 55.7%, and 33.3% in patients with septic shock, severe sepsis, and sepsis, respectively. Patients who died were significantly older than the survivors (mean age, 57.37 ± 20.42 years and 44.29 ± 15.53 years respectively, P < 0.01). Nonsurvivors were significantly more anemic and had higher APACHE II, SAPS II, SAPS III, and SOFA scores. The presence of acute respiratory distress syndrome and renal dysfunction were associated with higher mortality (75% and 70.2%, respectively). There was no significant difference in the duration of mechanical ventilation or ICU stay between survivors and nonsurvivors. On multivariate analysis, significant predictors of mortality with odds ratio greater than 2 included the presence of anemia, SAPS II score greater than 35, SAPS III score greater than 47, and SOFA score greater than 6 at day 1 of admission.Conclusion:Several demographic and laboratory parameters as well as composite critical illness scoring systems are reliable early predictors of mortality in sepsis. A sepsis mortality prediction formula (AIIMS Sepsis Score) based on SAPS II, SAPS III, and SOFA scores and hemoglobin has greater predictive power than these scoring methods individually. Routine use of critical illness scoring systems and a composite mortality prediction formula may provide useful early prognostic information in sepsis/severe sepsis.

829P - Early-Onset Hypothyroidism and Survival in Patients with Advanced Renal Cell Carcinoma Treated with First-Line Sunitinib: Updated Overall Survival Data

ABSTRACT Aim: Renal cell carcinoma is a heterogeneous disease; about 20% of the patients will show progression of the disease as their best response, while 25% will be long-term responders. Nowadays, the identification of potential predictive factors for these drugs is an unmet medical need. Methods: Data from patients with advanced renal cell carcinoma treated with first-line sunitinib were collected from four university hospitals in Spain, from 2006 to 2013. Patients with baseline thyroid dysfunction were excluded. We obtained information regarding clinical and pathological issues, as well as toxicities and clinical course of the disease. Hypothyroidism was defined as a level of TSH > 10 mUI/l in the first 12 weeks of therapy. Results: A total of 82 patients were analyzed, with a median age of 59,5 years (range 30 – 78). Clinical and pathological characteristics of the patients are summarized in Table 1. In the univariate analysis, there was a better progression-free survival (PFS) in the group of patients with hypothyroidism (19 vs 8 months, p = 0.005); this was also true for OS (41 vs 15 months, p = 0.009). Hypothyroidism was confirmed as an independent prognostic factor in the multivariate analysis, together with MSKCC prognostic group and nephrectomy. ECOG performance status and histology (clear cell / non-clear cell) were not significant for survival in the multivariate analysis. Conclusions: In our group of patients, the occurrence of hypothyroidism was strongly associated with a better outcome, with improvement both in PFS and OS. This association was confirmed in the multivariate analysis. These data support that the occurrence of hypothyroidism could be an early predictive factor of outcome for patients treated with first-line sunitinib. Disclosure: All authors have declared no conflicts of interest.

TCT-16 Index of microcirculatory resistance as an early predictive factor of LV remodeling after reperfused myocardial infarction

TCT-16 Index of microcirculatory resistance as an early predictive factor of LV remodeling after reperfused myocardial infarction

0195: Early predictive factors of LV remodeling after STEMI; assessment by coronary angiogram and cadiovascular magnetic resonance

Several months after acute ST elevation myocardial infarction (STEMI), many patients will develop left ventricular (LV) remodeling and heart failure. The aim of this study was to identify early predictive factors for LV remodeling (LVR) assessed by coronary angiogram and cardiovascular magnetic resonance (CMR) after STEMI. We prospectively included 52 patients with a first STEMI. All patients were successfully revascularized within 12 hours of chest pain onset using percutaneous coronary intervention (PCI). Angiographic parameters such as TIMI flow and blush grade were recorded. Index of microvascular resistance (IMR) was measured immediately after successful reperfusion. CMR was performed at days 4+/-2 days and at 6 months after STEMI. Comprehensive CMR included cine, T2-weighted, and late gadolinium enhancement (LGE) imaging allowing assessment of ventricular function, infarct size (IS), microvascular obstruction (MVO) and myocardial haemorrhage. LVR was defined as a >20% increase of LV volume at 6 months. LVR was observed in 34.8% of the patients (18/52). TIMI flow and blush grade after PCI was not different between patients with and without LVR (3 and 2 for TIMI flow and 2 and 2 for Blush grade respectively, p=0.952). However the IMR level markedly differed between patients with and without LVR (73,95 vs. 27,23 p=0,0293). After multivariate analysis IMR>40 was the strongest angiographic factor to predict LVR (OR 15 (1,030-218,4), p=0,03). Regarding CMR, patients with LVR had lower LVEF (43% vs. 48%; p=0.01), larger IS (51 mg vs 32 mg; p=0.002) and greater MVO extent (4.5seg vs. 2seg; p=0.03) when compared to patients with no LVR. IMR assessed by coronary angiogram, as well as IS and MVO extent assessed by CMR, are strong predictive factors of LV remodeling 6 months after STEMI.

Early dropout predictive factors in obesity treatment

Diet attrition and failure of long term treatment are very frequent in obese patients. This study aimed to identify pre-treatment variables determining dropout and to customise the characteristics of those most likely to abandon the program before treatment, thus making it possible to modify the therapy to increase compliance. A total of 146 outpatients were consecutively enrolled; 73 patients followed a prescriptive diet while 73 followed a novel brief group Cognitive Behavioural Treatment (CBT) in addition to prescriptive diet. The two interventions lasted for six months. Anthropometric, demographic, psychological parameters and feeding behaviour were assessed, the last two with the Italian instrument VCAO Ansisa; than, a semi-structured interview was performed on motivation to lose weight. To identify the baseline dropout risk factors among these parameters, univariate and multivariate logistic models were used. Comparison of the results in the two different treatments showed a higher attrition rate in CBT group, despite no statistically significant difference between the two treatment arms (P = 0.127). Dropout patients did not differ significantly from those who did not dropout with regards to sex, age, Body Mass Index (BMI), history of cycling, education, work and marriage. Regardless of weight loss, the most important factor that determines the dropout appears to be a high level of stress revealed by General Health Questionnaire-28 items (GHQ-28) score within VCAO test. The identification of hindering factors during the assessment is fundamental to reduce the dropout risk. For subjects at risk, it would be useful to dedicate a stress management program before beginning a dietary restriction.

Clinical outcome and predictors of mortality in children with sepsis, severe sepsis, and septic shock from Rohtak, Haryana: A prospective observational study.

Background:Information regarding early predictive factors for mortality and morbidity in sepsis is limited from developing countries.Methods:A prospective observational study was conducted to determine the clinical outcome and predictors of mortality in children with sepsis, severe sepsis, and septic shock. Children aged 1 month to 14 years admitted to a tertiary care pediatric intensive care unit (PICU) with a diagnosis of sepsis, severe sepsis, or septic shock were enrolled in the study. Hemodynamic and laboratory parameters which discriminate survivors from nonsurvivors were evaluated.Results:A total of 50 patients (30 [60%] males) were enrolled in the study, of whom 21 (42%) were discharged (survivors) and rest 29 (58%) expired (nonsurvivor). Median (interquartile range) age of enrolled patients were 18 (6, 60) months. Mortality was not significantly predicted individually by any factor including age (odds ratio [OR] [95% confidence interval [CI]]: 0.96 [0.91-1.01], P = 0.17), duration of PICU stay (OR [95% CI]: 1.18 [0.99-1.25], P = 0.054), time lag to PICU transfer (OR [95% CI]: 1.02 [0.93-1.12], P = 0.63), Pediatric Risk of Mortality (PRISM) score at admission (OR [95% CI]: 0.71 [0.47-1.04], P = 0.07) and number of organ dysfunction (OR [95% CI]: 0.03 [0.01-1.53], P = 0.08).Conclusion:Mortality among children with sepsis, severe sepsis, and septic shock were not predicted by any individual factors including the time lag to PICU transfer, duration of PICU stay, presence of multiorgan dysfunction, and PRISM score at admission.

Early Recurrence After Liver Resection for Colorectal Metastases: Risk Factors, Prognosis, and Treatment. A LiverMetSurvey-Based Study of 6,025 Patients

The aims of this study were to assess the risk of early recurrence after liver resection for colorectal metastases (CRLM) and its prognostic value; identify early recurrence predictive factors; clarify the effect of perioperative chemotherapy on its occurrence; and elucidate the best early recurrence management. Patients of the LiverMetSurvey registry who underwent complete liver resection (R0/R1) between 1998 and 2009 were reviewed. Early recurrence was defined as any recurrence that occurred within 6 months after resection. A total of 6,025 patients were included; 2,734 (45.4 %) had recurrence, including 639 (10.6 %) early recurrences. Early recurrence was mainly hepatic (59.5 vs. 54.4 % for late recurrences; p = 0.023). Independent risk factors of early recurrence were: T3-4 primary tumor (p = 0.0002); synchronous CRLM (p = 0.0001); >3 CRLM (p < 0.0001); 0-mm margin liver resection (p = 0.003); and associated intraoperative radiofrequency ablation (p = 0.0005). Response to preoperative chemotherapy (complete/partial) and administration of adjuvant chemotherapy reduced early recurrence risk (p = 0.003 and p < 0.0001, respectively). Intraoperative ultrasonography reduced hepatic early recurrence rate (p = 0.025). Early recurrence negatively affected prognosis: 5-year survival 26.9 versus 49.4 % for the late recurrence group (p < 0.0001, median follow-up 34.4 months). Overall, 234 (36.6 %) patients with early recurrence underwent re-resection. These patients had survival rates higher than non-re-resected patients (5-year survival 47.2 vs. 8.9 %; p < 0.0001) and similar to re-resected patients for late recurrence (48.7 %). Chemotherapy before early recurrence resection improved later survival (5-year survival 61.5 vs. 43.7 %; p = 0.028). Early recurrence risk is enhanced for extensive disease after poor preoperative disease control and inadequate surgical treatment, but is reduced after adjuvant chemotherapy. Although early recurrence negatively affects prognosis, re-resection may restore better survival. Chemotherapy before early recurrence resection is advocated.

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Introduction: Platelets are integral part of the body's hemostatic and immune system. Platelets may act directly and distinctly with different types of bacteria and up-regulate upon activation. Platelets express toll-like receptors that recognize pathogen-associated molecular patterns (PAMPS) such as lipopolysaccharides. We hypothesize that gram negative sepsis causes significant more thrombopoiesis than gram positive sepsis. Methods: Retrospective analysis of a convenient sample of septic patients admitted to the intensive care unit over a two year period. Platelet counts were extracted from the database and trended over a seven-day period (3 days prior to sepsis, and 3 days after a positive culture/ diagnosis of sepsis). Due to different thresholds among the clinicians, the day of sepsis was broadened to ± 1 day of obtaining a culture. The study population was divided into two groups based on the culture results [Gram positive organisms and Gram negative organisms]. Patients with mixed infections were excluded from further analysis. Wilcoxon-paired test was used to compare the trend between different time points. Results: A total of 88 patients were identified. Out of those, 60 patients had Gram negative culture and 28 had Gram positive culture. The majority of the patients were male (63%) with a mean age of 54 ± 11 years. Median SOFA score was 7 and median APACHE II of 22. Preseptic platelet count were as follows: <100: 46%, 100 – 200: 44%, > 200: 10%. Upon initiation of sepsis cultures were sent, platelet counts: <100: 33%, 100 – 200: 59%, > 200: 8%. Patients with Gram negative sepsis had a 47% ±12% relative increase in platelet count compared to Gram positive had a 12% ±4%.(p=0.001) The vast majority of patients had some increase in the platelet count before sepsis was suspected [70% and 73% for Gram negative and Gram positive respectively]. Conclusions: Patients with Gram negative sepsis develop an early transient increase in platelet count that could be used as an early predictive factor to guide further management of a septic patient. Further studies are needed to evaluate the various relationships of bacteria to platelet count in the preseptic phase and time of onset of sepsis.

The Kinetic Of Bone Marrow Fibrosis Regression Predicts Outcome In Myelofibrosis Patients After Allogeneic SCT

IntroductionBone marrow fibrosis is a hallmark of primary or post ET/PV myelofibrosis. Recent studies have shown that allogeneic stem cell transplantation induces rapid bone marrow fibrosis regression suggesting that fibrosis is more a dynamic rather than a static process. So far, no data are reported if fibrosis regression influences outcome after transplantation. Methods and patientsWe studied 94 patients with myelofibrosis who received allogeneic stem cell transplantation at the University Medical Center Hamburg between 2002 and 2010. In 57 patients the complete bone marrow histology prior transplantation and/or on day+30 and +100 after transplantation were available. The median age was 57 years (r: 33–73) and patients were classified as IPSS low-risk (n = 1), intermediate-1 (n = 5), intermediate-2 (n = 18), and high-risk (n = 33). Donor source was unrelated (n = 46) or related (n = 11) and of these 38 were HLA-matched while 19 were HLA-mismatched. 41 had primary and 16 post ET or post PV myelofibrosis. The median number of blasts was 1% (r: 0–17%) and gender was male (n = 32) and female (n = 25). All patients received busulfan-based dose-reduced conditioning regimen. Bone marrow fibrosis was graded according to the European consensus and WHO (MF-0 – 3), respectively, and evaluated by experienced hematopathologists. ResultsBefore transplantation 41 patients (72%) had MF grade 3 and 16 (28%) MF grade 2. After engraftment on day+30 (± 10 days) (n = 48), 3 (6%) had complete regression (MF-0) and 7 (15%) near complete regression of bone marrow fibrosis while 17 (35%) had MF-2 and 21 (44%) had MF-3. On day+100 (± 20 days) complete regression (MF-0) was noted in 11 (25%) and near complete regression (MF-1) in 13 (29%) while 12 (27%) and 8 (18%) had still MF-2 or MF-3, respectively. Patients with complete and near complete regression (MF-0 and MF-1) on day +30 had a 5-year estimated overall survival of 100% and those with MF-2 and MF-3 of 75% (p = 0.09). Patients with complete or near complete regression on day+100 had a 5-year estimated survival of 95% in contrast to 60% for those with MF-2 or MF-3 (p = 0.04).If analyzed by regression by grade at day+100 7 (16%) had a reduction of 3 grades (e.g. MF-3 to MF-0), 12 (27%) of 2 grades, 16 (36%) of 1 grade, and 9 (21%) had no grade reduction at day+100.Reduction of 2 or 3 grades at day+100 resulted in 95% survival at 5 years while reduction of 1 or no grade had a survival of 70% however this difference did not reach statistical significance (p = 0.1). There was no difference of fibrosis regression at day+100 between high risk IPSS and low/intermediate risk patients. Furthermore, in those patients with JAK2V617F mutation and complete or near complete regression 42% still had detectable JAK2V617F mutation level in peripheral blood. In contrast, 81% had complete donor cell chimerism if bone marrow fibrosis was MF-0/MF-1 while only 31% had complete chimerism at day+100 if fibrosis was classified as MF-2 or MF-3. ConclusionThis data on fibrosis regression after allogeneic stem cell transplantation suggests that a more rapid regression - independently of IPSS risk score - resulted in a favorable survival and may be used as an early predictive factor for excellent survival. Disclosures:No relevant conflicts of interest to declare.

Early Predictors of Health-Related Quality of Life Outcomes in Polytrauma Patients with Spine Injuries: A Level 1 Trauma Center Study

Study Design Retrospective review on clinical-quality trauma registry prospective data. Objective To identify early predictors of suboptimal health status in polytrauma patients with spine injuries. Methods A retrospective review on a prospective cohort was performed on spine-injured polytrauma patients with successful discharge from May 2009 to January 2011. The Short Form 12-Questionnaire Health Survey (SF-12) was used in the health status assessment of these patients. Univariate and multivariate logistic regression models were applied to investigate the effects of the Injury Severity Score, age, blood sugar level, vital signs, brain trauma severity, comorbidities, coagulation profile, spine trauma-related neurologic status, and spine injury characteristics of the patients. Results The SF-12 had a 52.3% completion rate from 915 patients. The patients who completed the SF-12 were younger, and there were fewer patients with severe spinal cord injuries (American Spinal Injury Association classifications A, B, and C). Other comparison parameters were satisfactorily matched. Multivariate logistic regression revealed five early predictive factors with statistical significance (p ≤ 0.05). They were (1) tachycardia (odds ratio [OR] = 1.88; confidence interval [CI] = 1.11 to 3.19), (2) hyperglycemia (OR = 2.65; CI = 1.51 to 4.65), (3) multiple chronic comorbidities (OR = 2.98; CI = 1.68 to 5.26), and (4) thoracic spine injuries (OR = 1.54; CI = 1.01 to 2.37). There were no independent early predictive factors identified for suboptimal mental health-related qualify of life outcomes. Conclusion Early independent risk factors predictive of suboptimal physical health status identified in a level 1 trauma center in polytrauma patients with spine injuries were tachycardia, hyperglycemia, multiple chronic medical comorbidities, and thoracic spine injuries. Early spine trauma risk factors were shown not to predict suboptimal mental health status outcomes.

Angiogenic biomarkers for prediction of early preeclampsia onset in high-risk women

Objective: Chronic hypertension, pregestational diabetes mellitus, history of prior preeclampsia and obese nulliparity are maternal conditions associated with increased preeclampsia risk. Whether altered maternal angiogenic factor levels allow for prediction of pending disease is unclear. Our objective was to evaluate angiogenic factors for early preeclampsia prediction in high-risk women.Methods: Serial serum specimens were collected from 157 women at high preeclampsia risk and 50 low-risk controls between 23 and 36 weeks gestation in 3 windows (23–27.6, 28–31.6, and 32–35.6 weeks) in a two-center observational cohort. Soluble fms-like tyrosine kinase-1 (sFlt1), placental growth factor (PlGF) and soluble endoglin (sEng) were measured by ELISA.Results: Multivariate parsimonious logistic regression analyses using backward elimination for prediction of early-preeclampsia (diagnosed < 34 weeks) found the best-fitting model included the predictors (1) sFlt1 measured in the second window (28–31.6 weeks) with AUC 0.85, sensitivity 67% and specificity 96% and (2) sFlt1 measured in the first window (23–27.6 weeks) and sEng change between first and second window with AUC 0.91, sensitivity 86% and specificity 96%.Conclusions: Two-stage sampling screening protocol utilizing sFlt1 and sEng is promising for prediction of preeclampsia diagnosed before 34 weeks. Larger studies are needed to confirm these findings.