Factors For Unfavorable Outcome Research Articles

Risk factors of unfavorable outcome of patients who experienced unplanned ICU admission following elective hepatobiliary & pancreas surgery

Risk factors of unfavorable outcome of patients who experienced unplanned ICU admission following elective hepatobiliary & pancreas surgery

Transcranial duplex sonography in assessing microsurgical treatment outcome for patients with ruptured cerebral artery aneurysms

Study objective. To determine the role of transcranial duplex sonography measurements in prognosing the risk of adverse outcome in patients with nontraumatic subarachnoid haemorrhage.Materials and Methods. In 2010–2020 413 patients admitted to N. V. Sklifosovsky Research Institute for Emergency Medicine of Moscow Healthcare Department with aneurysmatic subarachnoid haemorrhage were enrolled into the study, including 201 males (48.7 %) and 212 females (51.3 %). Mean age was 51 ± 12 years. All patients were treated surgically (aneurysm clipping). Patients’ status on admission and before surgery was evaluated according to Hunt and Hess scoring system. Transcranial duplex sonography was conducted in all patients on admission, before surgical treatment and on a daily basis after aneurysm clipping (up to the 10th day after aneurysm rupture, 2,612 examinations in total). The degree of angiospasm in middle cerebral artery, Lindegaard ratio and the presence of diffuse angiospasm in all arteries of Willis circle were assessed according to a previously described classification system. Brain computed tomography scans were used to determine the extent of subarachnoid haemorrhage according to C. M. Fisher scale and volume of ischemic lesions in areas supplied by middle cerebral artery. Outcomes were rated according to Glasgow Outcome Scale. Study sample was divided into two groups according to outcome. Group 1: adverse outcome (Glasgow Outcome Scale 1–3). Group 2: favorable outcome (Glasgow Outcome Scale 4–5). Binary logistic regression was applied to reveal risk factors for adverse outcome. To define long-term treatment outcome 104 patients (68 females, 36 males) were examined using neurologic scoring systems: Modified Rankin Scale, Barthel Index, Mini-Mental State Exam, Hospital Anxiety and Depression Scale.Results. Favorable outcome (group 2) was ascertained in 221 (53.5 %), unfavorable outcome (group 1) – in 192 (46.5 %) patients. The following independent risk factors for unfavorable outcome were detected: angiospasm in middle cerebral artery before surgery, severe angiospasm in middle cerebral artery and diffuse angiospasm. According to univariate analysis, daily increase in middle cerebral artery peak systolic velocity by 51.6 cm / s was associated with adverse outcome either. Binary logistic regression model was able to predict unfavorable outcome with sensitivity 88.5 %, specificity 76.0 %. Daily increase in middle cerebral artery peak systolic velocity by 58.7 cm / s was associated with Modified Rankin Scale increase by 1 point. Angiospasm proved to be strongly connected with cognitive and self-care ability impairment on follow-up.Conclusion. Ultrasonic signs of angiospasm in patients with aneurysmatic subarachnoid haemorrhage are independent predictors of adverse outcome and long-term results worsening.

PROGNOSTIC MEANING OF SERUM NSE AS THE FACTOR OF BAD OUTCOME IN SECONDARY BRAIN DAMAGE

This research is dedicated to the study of brain neuronspecific markers and indicators of brain damage outcome. Purpose of the study: To examine the prognostic role of serum NSE as the predictor of unfavorable outcome in traumatic and vascular brain damages. Methods: Prospective cohort study with 219 patients. Blood serum neuronspecific markers (NSE,S100B),acid-base state, blood gas were derived during the period of observation: upon enrolment, on the 3-rd, 5-th and 7-th days spent in the hospital in the intensive care unit. Results: The most significant risk factor of unfavorable outcome is the marker NSE with the cut point 12,5 ng|ml. The results of the analysis indicate the presence of a statistically significant direct relationship between NSE> 12.5 ng / ml and LDH, compared to other variables, 3.7 times more often; with an increase in blood lactate more than 4,1 mmol/l almost 3,8 times; with GCS 13 points below by 1,7 times; S100≥0,2 by 2,8 times; with an increase of PCO2 <38,5 it was documented more than 3 times often. The measure of certainty the resulting model by the pseudo R2 Nagelkerke criterion-250.6; logLikelihood - 154.04 which corresponds to the excellent predictive ability of the mathematical model. The best predictive value of the model is a cut-off point of 88.89%, AuROC-0.809; Se-51.59%; Sp-95.06%; NPV-55.80%; PPV-94.20%. This model can be used to predict the outcome in patients with acute cerebral pathology. Keywords: strokes, brain traumatic damages, neuronspecific markers, diagnostic and prognostic criterias, stroke outcomes.

Factors of unfavorable outcome of generalized peritonitis

Aim. To analyze clinical and bacteriologic factors associated with the occurrence of septic shock and mortality in patients with secondarily generalized peritonitis.Materials and methods. The analysis of the results of the examination and treatment of 180 patients with generalized peritonitis was carried out. Patients were divided into two groups: the first group of 74 patients (41.1%) who had septic shock and the second group of 106 patients (58.9%) without a record of septic shock. Further, subgroups of patients with community-acquired and postoperative generalized peritonitis were identified in a ratio of 112/68.Results and discussion. Mortality among patients with community-acquired peritonitis was 21% and among patients with postoperative peritonitis - 16%. 42 (37%) patients with community-acquired peritonitis developed septic shock compared with 32 (47%) cases of shock among patients with postoperative peritonitis. Patients who developed septic shock were significantly older than patients without septic shock in both subgroups. In both types of generalized peritonitis, anaerobes are significantly associated with septic shock.Conclusions. It was revealed that age over 65 years, two or more microorganisms of the peritoneal fluid, or anaerobes were independent risk factors for the development of septic shock. Peritoneal exudate yeast and enterococci were associated with septic shock in a subgroup of patients with community-acquired peritonitis. Yeast was associated with high mortality in postoperative peritonitis.

ВОЗМОЖНЫЕ ПРИЧИНЫ ФОРМИРОВАНИЯ РЕЦИДИВОВ ТУБЕРКУЛЕЗА У ДЕТЕЙ В СОВРЕМЕННЫХ УСЛОВИЯХ: КЛИНИЧЕСКИЕ НАБЛЮДЕНИЯ

The epidemiological situation of tuberculosis (TB) has been improving steadily in recent years however, in the structure of TB patients, there is a high proportion of patients with multidrugresistant/extensively drug-resistant (XDR) pathogens and people with HIV and TB co-infection. As a result, cases of TB disease in children with many risk factors for unfavorable outcome of therapy are recorded, leading to subsequent relapse. the aim of the work was to analyze possible causes of formation and structure of clinical forms of recurrence of TB in children. A retrospective analysis of outpatient cards and medical records of children of residents of the Leningrad region, who had a TB relapse, was carried out. It has been established that in Leningrad Oblast, there were 3 cases of recidivism of TB among children registered from 2011 to 2020. The main risk factor for the development of primary TB was the lack of immunization against TB due to perinatal contact with an HIV-infected mother. The provoking factors of TB relapse were the occurrence of exogenous superinfection of TB, the presence of HIV infection in the child, the presence of large residual changes after primary TB, close contact with a TB patient with an XDR of the causative agent.

Teicoplanin versus \u03b2-lactam for febrile patients with Staphylococcus-like bacteremia: focus on methicillin-susceptible Staphylococcus aureus bacteremia

BackgroundMany studies have shown that vancomycin is inferior to β-lactam antibiotics in terms of effectiveness in the treatment of methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. However, limited data are available regarding the comparison of clinical outcomes between patients receiving initial teicoplanin and those receiving β-lactam antibiotics for MSSA bacteremia.MethodsEighty-four adults with MSSA bacteremia were included: initial teicoplanin treatment group (n = 28) and β-lactam treatment group (n = 56). The two groups were further stratified based on propensity score matching according to the outcome analysis using a logistic regression model. We investigated the clinical outcomes between the groups before and after propensity score matching after treatment completion.ResultsPittsburgh bacteremia score ≥ 4 (odds ratio, 60.6; 95%CI, 7.4–496.8) was an independent risk factor for unfavorable outcome. After propensity score matching, the initial teicoplanin treatment group and the β-lactam treatment group consisted of 28 patients each. No statistically significant differences were observed in the proportions of patients with favorable outcomes and 30-day overall mortality rates between the groups before and after propensity score matching after the completion of teicoplanin or β-lactam treatment. The Kaplan-Meier 30-day survival curve also showed no significant difference between the patients receiving initial teicoplanin treatment and those receiving β-lactam treatment before and after matching (hazard ratio, 1.84, 95%CI, 0.60–5.64; and 3.12, 95%CI, 0.98–9.99, respectively).ConclusionsThere were no significant difference in clinical outcomes between initial teicoplanin treatment and β-lactam treatment among patients with MSSA bacteremia. Pittsburgh bacteremia score ≥ 4 was a significant risk factor for mortality.

Multidrug-resistant organisms (MDROs) in patients with subarachnoid hemorrhage (SAH)

Patient care in a neurointensive care unit (neuro-ICU) is challenging. Multidrug-resistant organisms (MDROs) are increasingly common in the routine clinical practice. We evaluated the impact of infection with MDROs on outcomes in patients with subarachnoid hemorrhage (SAH). A single-center retrospective analysis of SAH cases involving patients treated in the neuro-ICU was performed. The outcome was assessed 6 months after SAH using the modified Rankin Scale [mRS, favorable (0–2) and unfavorable (3–6)]. Data were compared by matched-pair analysis. Patient characteristics were well matched in the MDRO (n = 61) and control (n = 61) groups. In this center, one nurse was assigned to a two-bed room. If a MDRO was detected, the patient was isolated, and the nurse was assigned to the patient infected with the MDRO. In the MDRO group, 29 patients (48%) had a favorable outcome, while 25 patients (41%) in the control group had a favorable outcome; the difference was not significant (p > 0.05). Independent prognostic factors for unfavorable outcomes were worse status at admission (OR = 3.1), concomitant intracerebral hematoma (ICH) (OR = 3.7), and delayed cerebral ischemia (DCI) (OR = 6.8). Infection with MRDOs did not have a negative impact on the outcome in SAH patients. Slightly better outcomes were observed in SAH patients infected with MDROs, suggesting the benefit of individual care.

Neurointensive care results and risk factors for unfavorable outcome in aneurysmatic SAH: a comparison of two age groups

BackgroundThe mean age of actively treated subarachnoid hemorrhage (SAH) patients is increasing. We aimed to compare outcomes and prognostic factors between older and younger SAH patients.MethodsA retrospective single-center analysis of aneurysmal SAH patients admitted to a neuro-ICU during 2014–2019. We defined older patients as ≥70 years and younger patients as <70 years. For every older patient, we identified three younger patients with the same World Federation of Neurological Surgeons (WFNS) grade. We only included patients receiving active aneurysm treatment. Favorable functional outcome, defined as a Glasgow Outcome Scale (GOS) of 4–5 at 12 months, was our primary outcome. We used logistic regression to compare prognostic factors between the groups.ResultsNinety-five (85%) of 112 older patients and 317 (94%) of 336 younger patients received aneurysm treatment. Of the younger patients, 91% with a good-grade SAH (WFNS I-III) had a favorable outcome compared to 52% in the older good-grade SAH group. In poor-grade patients (WFNS IV-V), favorable outcome was seen in 51% of younger patients, compared to 24% of older patients. Acute hydrocephalus and intracerebral hemorrhage were associated with unfavorable outcome in the younger (OR 4.7, 95% CI 2.6–8.4, and OR 3.7, 95% CI 2.1–6.4), but not in the older patients (OR 1.8, 95% CI 0.8–4.2, and OR 1.3, 95% CI 0.5–3.1, respectively).ConclusionsIn actively treated SAH patients, age was a major determinant of outcome. Factors reflecting increases in intracranial pressure associated with outcome only among younger patients.

Management before the norwood procedure: correction of risk factors of unfavourable outcome

Management before the norwood procedure: correction of risk factors of unfavourable outcome

Risk Stratification of Patients with COVID-19 Presenting at the Emergency Department

Background: Since the outbreak of the coronavirus disease 2019 (COVID-19) clinical characteristics and risk factors for unfavorable outcome of patients with CO

Carbon dioxide elimination pattern at cardiopulmonary exercise testing in patients with low ejection fraction value

The objective of this study was to evaluate partial pressure of end tidal carbon dioxide (PetCO2) over time on exertion (E) and its predictive value in evaluation of risk of unfavorable outcome in patients with low ejection fraction (EF) value.Materials and Methods. Patients (n = 53) with pronounced chronic heart failure (CHF), included in heart transplantation waiting list, were enrolled in the prospective study. All patients underwent cardiopulmonary exercise testing (CPET). Mortality or INCOR left ventricle bypass system implantation according to vital indications within 1 year of follow-up were evaluated as an end-point.Results. Patients with CHF and low EF were characterized by low parameters of E tolerance and peak oxygen consumption (10.4 (9.6–11.7) ml/min/kg). The average PetCO2 level by group was 30.4 (28.3–33.0) mm Hg; in 32% of patients this value decreased or did not change in CPET compared with that in resting state. The significant relationship between increased risk of unfavorable outcome within 1 year of follow-up with low baseline PetCO2 value (odds ratio (OR) – 0.22 (0.05–0.87); p = 0.020) and absence of its increment in PE (OR – 0.16 (0.10–0.54); p = 0.009) was observed.Conclusion. The significant predictive factors of unfavorable outcome within 1 year of follow-up in patients with pronounced CHF and low EF include PetCO2 value in resting state, as well as PetCO2 change over time after E challenge.

Courbes de survie à plus de 10 ans des prothèses trapézo-métacarpiennes: à propos de 294 cas

Thumb carpometacarpal osteoarthritis affects many post-menopausal women. If medical treatment fails, the most common options are trapeziectomy and trapezio-metacarpal arthroplasty. The purpose of this study was to evaluate the survival rate of trapezio-metacarpal prostheses in surgical treatment of thumb carpometacarpal osteoarthritis, and to highlight potential risk factors of unfavorable outcome. We performed a retrospective study involving 294 trapezio-metacarpal prostheses in 245 patients, who underwent surgery between 2001 and 2016. Clinical assessment was performed by self-questionnaire including pain, satisfaction, recovery time, QuickDASH Score, and opposition according to Kapandji score. Thumb X-rays were used to evaluate implant loosening sign, periprosthetic remodeling, and arthrosis of over and underlying joints. Implants survival rate at the final follow-up of 17.3 years was 90.8 % (95 % CI [85.8–96.1]). Median pain was 1 on 10 on VAS scale (0–8). Median QuickDASH Score was 20 (0–82), median opposition according to Kapandji was 9 on 10 (3–10). Median return to work time was 2 months (1–12). We identified 7.8 % of major complications, including 3.4 % of dislocations, 3.1 % of implants loosening, and 1 % of fractures. All dislocations involved surgical revision. Only few publications show results with more than 100 trapezio-metacarpal prostheses. Our results are consistent with existing studies. Trapeziectomy represents currently the gold standard in surgical treatment of thumb carpometacarpal osteoarthritis. Long-term superiority has not been proven in recent meta-analysis. Two recent studies found superiority of arthroplasty at short term concerning pain, strength, mobility, satisfaction, and recovery time, with similar complication rates. Trapezio-metacarpal arthroplasty is a long-term reliable solution for surgical treatment of thumb carpometacarpal osteoarthritis, with a limited complication rate.

Past history of stage I/II solid tumor malignancy impacts considerably on sepsis mortality: a propensity score matching analysis from the hellenic sepsis study group

BackgroundWhether past history of solid stage I/II inactive cancer has an impact on 28-day mortality of sepsis remains unclear. We aimed to determine the impact of history of stage I or II solid tumor malignancy in complete remission the last 3 years on sepsis outcome.MethodsUsing the database of the Hellenic Sepsis Study Group from 1553 patients with sepsis admitted in the ICU, 83 patients with sepsis by Sepsis-3 definition with past-history of stage I/II inactive solid malignancy the last 3 years were depicted. A comparator group of 83 patients fully matched for age, severity, type of infection and comorbidities was selected by propensity score matching.ResultsMortality after 28 days was 37.3% in the comparator group and 54.2% in the solid tumor stage I/II group (odds ratio for death 1.98; p: 0.030). Following step-wise forward Cox regression analysis, septic shock (hazard ratio 1.80), acute renal injury (hazard ratio 2.06), history of coronary heart disease (hazard ratio 0.36) and history of stage I/II solid tumor malignancy (hazard ratio 1.79) were the only independent variables associated with 28-day mortality. Serum levels of procalcitonin and of soluble urokinase plasminogen activator receptor were similar between the two groups of comparisons.ConclusionsPast history of stage I/II solid malignancy is an independent risk factor for unfavorable outcome from sepsis the first 28 days.

Personified Approaches to Reperfusion Therapy of Ischemic Stroke

Introduction: Systemic thrombolytic therapy (STLT) with recombinant tissue plasminogen activator (rtPA) is the “gold standard” of reperfusion therapy in certain patients with ischemic stroke during the first 4.5 h after stroke onset. Objective: To assess the clinical (severity of neurological symptoms) and laboratory (complete blood cell count test) factors that affect the disease outcome after STLT. Materials and methods: Seventy patients (48 males and 22 females) aged 61 [54; 69] years with ischemic stroke who received rtPA therapy at a dose of 0.9 mg/kg were prospectively studied. Blood for the complete blood count test including neutrophil and lymphocyte counts was sampled before the thrombolytic therapy. The severity of neurological impairment was assessed using the NIH Stroke Scale (NIHSS). The functional outcome was assessed 3 months after stroke with the modified Rankin scale (mRS). ROC analysis was used to reveal factors of unfavorable outcome in acute phase of ischemic stroke (mRS score ≥ 3). Results: Severity of neurological deficit was assessed according to the NIHSS at admission was 15 [11; 17] points. Time between the manifestation of neurological symptoms and admission to the hospital was 138 [117; 170] min, and time between admission and initiation of STLT (the door-to-needle time), was 40 [30; 55] min. An unfavourable functional outcome of systemic thrombolytic therapy can be predicted according to the results of ROC analysis: the NIHSS score upon admission 12 or higher (sensitivity, 94%; specificity, 57%); neutrophil count, >7.8 × 109/L (sensitivity, 45.5%; specificity, 90.6%); lymphocyte count < 1.8 × 109/L (sensitivity, 81.8%; specificity, 59.4%). Conclusions: Personalized approach to systemic thrombolytic therapy may help to predict its effectiveness and contribute the development of more reliable strategies of patient management. Patients with potentially unfavorable outcome after intravenous thrombolysis can be the target group for mechanical reperfusion techniques such as thrombus extraction.

Abstract WP65: Higher Glucose Level Associated With Unfavorable Outcome in Acute Minor Ischemic Stroke After Thrombolytic Therapy

Introduction: In real world practice, patients with minor stroke symptoms are still treated with thrombolytic therapy and majority of them recover with favorable outcomes at 90 days, but there is room to identify avenues to further enhance their outcomes. We aimed to investigate the risk factors associated with the unfavorable outcome at 90 days after thrombolysis for acute minor ischemic stroke (AMIS). Methods: 152 consecutive patients presented with AMIS (NIHSS ≤3) and received intravenous alteplase between December 2012 and February 2017. Baseline clinic-demographic, characteristics and laboratory tests were recorded. Unfavorable outcome was defined as modified Rankin Scale (mRS) of 2-6 at 90 days. Univariate analysis followed by multivariate analysis was used to identify risk factors for unfavorable outcome. A receiver operating characteristic curve was used to evaluate the predictive value. Results: 113 out of 152 patients (74%) were included in the final analysis, age 59 (53-67), 72.6% men. 32 patients (28.3%) experienced unfavorable outcomes. After adjusting for covariates, only serum glucose level on admission remained an independent factor for unfavorable outcome (OR 1.43, 95% CI: 1.10-2.72, p =0.014), with a 0.617 predictive value for the unfavorable outcome. Conclusions: About 28% of patients with AMIS in this cohort had an unfavorable outcome at 3 months after thrombolysis. Addressing higher serum glucose level on admission may be a viable therapeutic strategy to improve prognoses in these patients.

The Complexity of Pediatric Multifocal Atrial Tachycardia and Its Prognostic Factors.

Background and ObjectivesMultifocal atrial tachycardia (MAT), in general, has a favorable outcome. However, there are insufficient data regarding MAT in a pediatric population. This study sought to determine the clinical course of MAT and identify potential prognostic factors.MethodsThe medical records of MAT patients from 1997–2015 were reviewed. The arrhythmia control rate and factors for unfavorable outcomes were assessed and compared to those in the literature.ResultsOf the 33 included patients (19 boys and 14 girls), 27 were infants less than 1 year of age. The median age at diagnosis was 1.7 months (range, 0 day to 14 years). Fourteen (42%) patients had structural heart disease. Eight (24%) patients had lung disease and 6 (18%) had a syndromic diagnosis belonging to RASopathy. Two patients developed polymorphic ventricular tachycardia, in whom genetic analysis confirmed the presence of the RyR2 mutation several years later. MAT was controlled in 26 patients (84%) within 3.9 months (median; range, 16 days–18.4 years) using an average of 2.4 medications. There were 3 cases of cardiopulmonary mortality. The arrhythmia control rate was higher in the infant group (85%) than in the non-infant group (67%), although this trend was not statistically significant. There was a significantly lower rate of unfavorable outcomes in the idiopathic infant group (n=11) than in the other groups (p=0.008). Considering the findings of previous studies, the mortality rate was significantly higher in patients with structural heart disease than in patients without (21% vs. 5%, p=0.01).ConclusionsMAT usually affects infants and has a favorable prognosis, particularly in the idiopathic infant group. However, in the presence of other comorbidities, MAT may have a variable clinical course.

Predictive Factors for Unfavorable Outcomes of Tuberculous Pericarditis in Human Immunodeficiency Virus-Uninfected Patients in an Intermediate Tuberculosis Burden Country

In areas where Mycobacterium tuberculosis is endemic, tuberculosis is known to be the most common cause of pericarditis. However, the difficulty in diagnosis may lead to late complications such as constrictive pericarditis and increased mortality. Therefore, identification of patients at a high risk for poor prognosis, and prompt initiation of treatment are important in the outcome of TB pericarditis. The aim of this study is to identify the predictive factors for unfavorable outcomes of TB pericarditis in HIV-uninfected persons in an intermediate tuberculosis burden country. A retrospective review of 87 cases of TB pericarditis diagnosed at a tertiary referral hospital in South Korea was performed. Clinical characteristics, treatment outcomes, complications during treatment, duration of treatment, and medication history were reviewed. Unfavorable outcome was defined as constrictive pericarditis identified on echocardiography performed 3 to 6 months after initial diagnosis of TB pericarditis, cardiac tamponade requiring emergency pericardiocentesis, or death. Predictive factors for unfavorable outcomes were identified. Of the 87 patients, 44 (50.6%) had unfavorable outcomes; cardiac tamponade (n = 36), constrictive pericarditis (n = 18), and mortality (n = 4). 14 patients experienced both cardiac tamponade and constrictive pericarditis. During a 1 year out-patient clinic follow up, 4 patients required repeat pericardiocentesis and pericardiectomy was performed in 0 patients. In the multivariate analysis, patients with large amounts of pericardial effusion (P = .003), those with hypoalbuminemia (P = .011), and those without cardiovascular disease (P = .011) were found to have a higher risk of unfavorable outcomes. HIV-uninfected patients with TB pericarditis are at a higher risk for unfavorable outcomes when presenting with low serum albumin, with large pericardial effusions, and without cardiovascular disease.

The prognostic factors of unfavorable outcome of acute transient psychotic disorders

The study was carried out to investigate prognostic factors of outcomes of transient psychotic disorders/ The sampling included 168 patients with psychotic states meeting diagnostic criteria of ICD-10 for the given group of diseases (F 23.0; F 23.1; F 23.2; F 23.3; F 23.8; F 23.9). The clinical psychopathologic, clinical catamnesis, psychometric and statistical methods were applied. The data concerning characteristics of course of various clinical alternatives of acute transient psychotic disorders is presented. A number of characteristics associated with subsequent development of secondary psychotic attack was established. The characteristics indicating lingering course of the first psychotic episode had the most prognostic significance as regards development of relapse of disease.

A Randomized Phase Ii Study of Paclitaxel-Carboplatin-Bevacizumab (Pcb) with or Without Nitroglycerin Patches (Ntg) in Patients (Pts) with Stage Iv Non-Squamous-Non-Small Cell Lung Cancer (Ns-Nsclc)(Nvalt 12), Impact of Circulating Vascular Endothelial Growth Factor (Vegf) Levels

ABSTRACT Aim: NTG added to standard chemotherapy has been shown to improve clinical outcome. NTG is hypothesized to increase tumor blood flow and may augment drug delivery to the tumor and diminish tumor hypoxia causing a decrease in VEGF. High circulating VEGF is a prognostic factor for unfavourable outcome. We showed that adding NTG to PCB (PCB + N) did not improve progression free survival (PFS), response rate (RR) and overall survival (OS) in pts with stage IV NS-NSCLC (NCT01171170; Dingemans, ASCO 2014). Here we present impact of baseline VEGF on clinical outcome. Methods: In this open-label multicenter phase II trial chemo-naive pts with stage IV NS-NSCLC were randomized 1:1 to PCB or PCB + N. Pts were treated with P 200 mg/m2 day (d) 1-C AUC 6 d1-B 15 mg/kg d1 every 3 weeks (wks) or PCB + NTG 15 mg/24 h for 5 d (d -2 to +3) every cycle for 4 cycles and B + N until progression. The study was powered (80%) to detect a decrease in the hazard of progression of 33% at a = 0.05 with a two-sided log rank test. As pre-planned exploratory analysis baseline, wks 3 and 6 free circulating VEGF levels by ELISA were assessed. Results: 223 pts were randomized; 112 PCB and 111 PCB + N; Median (95% CI) PFS in PCB was 6.8 months (m) (5.6-7.3) and 5.0 m (4.2-5.8) in PCB + N, HR 1.22 (0.91-1.63). OS was 11.6 m (8.7-14) in PCB and 9.5 m (7.8-11.9) in PCB + N, HR 1.12 (0.76-1.67). Baseline median VEGF (n = 178) was 111 pg/ml (inter-quartile range 55-218), equal between 2 arms. High VEGF levels (n = 89) at baseline was associated with worse OS (p = 0.02) and PFS (p = 0.0003). For pts with above median VEGF at baseline, OS and PFS were not different for PCB and PCB + N, for pts with below median VEGF there was a trend for worse PFS HR 1.46 (0.95 – 2.24) and OS HR1.55 (0.97-2.49) in the pts treated with PCB + N. In both arms VEGF became undetectable or very low at 3 and 6 wks. Conclusions: Adding NTG to first line PCB does not improve PFS and OS in pts with stage IV NS-NSCLC. As the mechanism of action of NTG is presumably through the VEGF pathway, decrease of VEGF levels by B may preclude an additional effect of NTG. Disclosure: A.C. Dingemans: advisory board Roche; H.J.M. Groen: advisory board roche E.F. Smit: advisory board roche; J.G. Aerts: advisory board roche. All other authors have declared no conflicts of interest.

EXPERIENCE OF ABATACEPT TREATMENT IN A PATIENT WITH SEROPOSITIVE POLYARTHRITIS FROM RISK GROUP OF TUBERCULOSIS INFECTION

A short review on modern views on abatacept usage in treatment of juvenile idiopathic arthritis is shown in this article with highlighting of the high safety of this drug in accordance with severe opportunistic infections, including tuberculosis. The authors also discuss possibility of its usage in cases of inefficiency (intolerability) of tumor necrosis factor alpha in combination with methotrexate or as monotherapy. A history case of abatacept treatment of polyarticular type of juvenile idiopathic arthritis with risk factors of unfavorable outcome, severe associated disease and latent tuberculosis infection is demonstrated.