Higher Albumin Levels Research Articles

Renal involvement is frequent in adults with primary mitochondrial disorders: an observational study.

Mitochondrial functions are controlled by genes of both mitochondrial and nuclear DNA. Pathogenic variants affecting any of these are responsible for primary mitochondrial disorders (MIDs), which can be diagnosed during adulthood. Kidney functions are highly dependent on mitochondrial respiration. However, the prevalence of MID-associated nephropathies (MIDANs) is unknown in the adult population. We aimed to address this point and to provide a full characterization of MIDANs in this population. We retrospectively included for observational study adults (≥16 years of age) with genetically diagnosed MID between 2000 and 2020 in our tertiary care academic centre when they had a chronic kidney disease (CKD) evaluation. MIDANs were ascertained by CKD occurring in MIDs. The phenotypic, biological, histopathological and genotypic characteristics were recorded from the medical charts. We included 80 MID-affected adults and ascertained MIDANs in 28/80 (35%). Kidney diseases under the care of a nephrologist occurred in only 14/28 (50%) of the adults with MIDAN. MIDANs were tubulointerstitial nephropathy in 14/28 patients (50%) and glomerular diseases in 9/28 (32.1%). In adults with MID, MIDAN was negatively associated with higher albumin levels {odds ratio [OR] 0.79 [95% confidence interval (CI) 0.67-0.95]} and vision abnormalities [OR 0.17 (95% CI 0.03-0.94)] and positively associated with hypertension [OR 4.23 (95% CI 1.04-17.17)]. MIDANs are frequent among adult MIDs. They are mostly represented by tubulointerstitial nephropathy or glomerular disease. Vision abnormalities, hypertension and albumin levels were independently associated with MIDANs. Our results pave the way for prospective studies investigating the prevalence of MIDANs among undetermined kidney disease populations.

Prognostic Factors in Patients Treated with Pembrolizumab as a Second-Line Treatment for Advanced Biliary Tract Cancer.

Simple SummaryThe five-year survival rate for advanced biliary tract cancer (BTC) is still less than 10%. Moreover, there is no established second-line chemotherapy after the failure of the first-line chemotherapy. Pembrolizumab is known to be an effective treatment in advanced BTC, but the prognostic factors of pembrolizumab are unknown. The purpose of this study is to provide guidelines for selecting treatment alternatives for BTC patients with refractory to gemcitabine-based chemotherapy, by exploring the prognostic factors of pembrolizumab in BTC.Some BTC types respond to pembrolizumab, but there are no known prognostic factors to predict its treatment benefits. In this study, we attempted to identify the prognostic factors associated with pembrolizumab as a second-line treatment for gemcitabine-refractory BTC. This retrospective and single tertiary-center study involved all the consecutive patients (n = 80) with refractory advanced BTC, who were diagnosed as programmed cell death ligand 1-positive and treated with pembrolizumab between August 2017 and February 2021. The overall survival (OS) was analyzed using Cox regression analysis. The median OS was 6.0 months [95% confidence interval (CI): 3.87–8.20]; median progression-free survival was 1.9 months (95% CI: 1.82–1.98); and the response rate was 15.9%. In the multivariate Cox regression analysis, the TB [adjusted hazard ratio (HR) = 2.286; 95% CI: 1.177–4.440; p = 0.015), albumin levels (adjusted HR = 0.392; 95% CI: 0.211–0.725; p = 0.003), ALP levels (adjusted HR = 1.938; 95% CI: 1.105–3.400; p = 0.021), and LMR (adjusted HR = 0.325; 95% CI: 0.173–0.609; p < 0.001) were identified as significant variables associated with the OS. High albumin levels and LMR and low ALP levels and TB were significantly associated with better OS in patients treated with pembrolizumab.

Trough Concentration Deficiency of Rivaroxaban in Patients With Nonvalvular Atrial Fibrillation Leading to Thromboembolism Events.

This retrospective study investigated factors influencing the steady-state trough concentrations (C trough ) of rivaroxaban in patients with nonvalvular atrial fibrillation (NVAF). We retrieved data from patients with NAVF who first started rivaroxaban anticoagulation at the Fujian Provincial Hospital from October 2017 to October 2020 through the electronic medical record system. Patients were followed for 1 year after the first dose of rivaroxaban, and the primary efficacy and safety end points were recorded. All follow-up visits were completed by October 2021. A C trough of <12 ng/mL was defined as C trough deficiency. Factors that influenced rivaroxaban C trough deficiency were investigated using multivariate binary logistic regression analysis. Kaplan-Meier survival curve analysis was used to determine differences between C trough deficiency and event-free survival. A total of 167 patients with NVAF were enrolled in the study, including 113 men and 54 women, with an average (± SD) age of 70.40 ± 12.46 years. High albumin levels were an independent protective factor against C trough deficiency (odds ratio, 0.932; P = 0.031). C trough deficiency was associated with the probability of freedom from thrombotic events ( P = 0.004); however, there were no significant differences in the probability of freedom from bleeding events ( P > 0.05). In conclusion, among the variables studied, a low albumin level was the main contributor to C trough deficiency. Rivaroxaban C trough deficiency also increased thrombotic events, but this was not associated with hemorrhagic events in Chinese patients with NVAF.

Can serum albumin level affect the transcutaneous bilirubinometry in term neonates?

Jaundice is the quite common benign condition in neonates, but due to its potential toxicity, neonates must be monitored. This study was aimed to evaluate the effect of serum albumin level on the transcutaneous bilirubin (TcB) measurements in term neonates with unconjugated hyperbilirubinemia. Serum albumin and total serum bilirubin (TSB) of 252 jaundiced term neonates were estimated and simultaneously TcB was measured over sternum and the effect of serum albumin on TcB measurements was evaluated. The correlation between TSB and TcB was linear and significant for the entire cohort. When this correlation was studied separately in the groups with different albumin levels, maximum correlation (r = 0.888, R2 linear = 0.789, p < 0.001) was observed in group 1 with hypo-albuminemia followed by in group 2 with normal albumin levels (r = 0.854, R2 linear = 0.729, p < 0.001) and group 3 with higher albumin levels (r = 0.809, R2 linear = 0.689, p < 0.001). Bland-Altman plot analysis of whole study population demonstrate good agreement between TSB and TcB [95% CI = -0.038 to 0.493 mg/dL, 17/252 = 6.75% outside the limits of agreement, Mean difference = 0.227]. This analysis in different groups also show good agreement between TSB and TcB. The correlation between the TSB and TcB may affected by serum albumin level. Therefore, transcutaneous bilirubinometry is not able to replace invasive TSB measurement. However, in the absence of TSB it could be an alternative to measure the level of bilirubin in term neonates.

Association of Serum Albumin and Copeptin with Early Clinical Deterioration and Instability in Community-Acquired Pneumonia.

Background: There is a paucity of data on biomarkers for the early deterioration and clinical instability of patients in community-acquired pneumonia (CAP), as treatment failure occurs in the first seven days in 90% of patients. Aim: To evaluate serum albumin and copeptin with CURB-65, PSI scoring and ATS/IDSA minor criteria for the prediction of early mortality or ICU-admission (7 days) and clinical instability after 72 h. Methods: In 100 consecutive hospitalized adult CAP patients, PSI-scores, CURB-65 scores, ATS/IDSA 2007 minor criteria, copeptin and albumin on admission were evaluated. Univariate and multivariate Cox regression analysis was performed to assess independent risk factors for early combined mortality or ICU admission. Predictive powers of albumin and copeptin were tested with ROC curves and ICU-free survival probability was tested using Kaplan−Meier analysis. Results: Albumin was lower and copeptin higher in patients with short-term adverse outcomes (p < 0.05). Cox regression analysis showed that albumin [HR (95% CI): 0.41 (0.18−0.94, p = 0.034)] and copeptin [HR (95% CI): 1.94 (1.03−3.67, p = 0.042)] were independent risk factors for early combined mortality or ICU admission (7 days). The Kaplan−Meier analysis observed that high copeptin (>27.12 ng/mL) and low albumin levels (<2.85 g/dL) had a lower (p < 0.001) survival probability. The diagnostic accuracy of albumin was better than copeptin. The inclusion of albumin and copeptin into ATS/IDSA minor criteria significantly improved their predictive power. Conclusions: Both biomarkers serum albumin and copeptin can predict early deterioration and clinical instability in hospitalized CAP patients and increase the prognostic power of the traditional clinical scoring systems.

Health Assessment in Adolescents Transitioning from High School to University Based on Their Hematological Parameters

Background: The transition from high school to university can impair the adaptive potential of adolescents. Objective: To assess the level of adaptation of freshmen to higher education environment based on their blood parameters. Materials and methods: Blood samples were collected from healthy 17-year-old adolescents (n = 50) on the first week at university and then two and six weeks after. The general blood test was accompanied by measurements of protein and protein fractions, immunoglobulins A, M and G, cortisol and testosterone levels. Nonspecific adaptive reactions of the body were assessed by the lymphocyte count. Results: The level of cortisol in the blood was higher or equal to the upper limit of the normal range in 50.0 to 70.0 % of the adolescents at different stages of observation. At the beginning of the study, the lymphocyte count indicated stress in 10.0 % of the students, and 1.5 months after, it demonstrated overactivation of the immune response already in 35.0 % of the freshmen. The levels of albumins and α1-globulins increased while α2 -, β-, and γ-globulins decreased; serum immunoglobulins M increased and immunoglobulins A were below the normal range, indicating impairment of humoral immunity. The compensatory response was manifested by an increased mean corpuscular volume, a decreased amount of hemoglobin in erythrocyte, a low hemoglobin concentration in the cell volume, and a decreased mean platelet volume. High albumin levels in conjunction with changes in red blood demonstrated an electrolyte imbalance, while decreased testosterone levels against the increased cortisol ones showed the prevalence of catabolic processes in the body. Conclusion: Hematological parameters provide objective information about the health status of first-year university students. They are related to previous competitive selection that included evaluation of medical contraindications and physical fitness, examination stress, and adaptation to novel learning conditions, and require timely correction.

Tailored Risk Stratification in Severe Mitral Regurgitation and Heart Failure Using Supervised Learning Techniques

BackgroundSecondary mitral regurgitation (sMR) in the setting of heart failure (HF) has considerable impact on quality of life, HF rehospitalizations, and mortality. Identification of high-risk cohorts is essential to understand disease trajectories and for risk stratification. ObjectivesThis study aimed to provide a structured decision tree–like approach to risk stratification in patients with severe sMR and HF. MethodsThis observational study included 1,317 patients with severe sMR from the entire HF spectrum. Clinical, echocardiographic, and laboratory data were extracted for all patients. The primary end point was all-cause mortality. Survival tree analysis, a supervised learning technique, was applied to identify patient subgroups at risk of mortality and further stratified by HF subtype (preserved, mildly reduced, and reduced ejection fraction). ResultsUsing supervised learning (survival tree method), 8 distinct subgroups were identified that differed significantly in long-term survival. Subgroup 7, characterized by younger age (≤66 years), higher hemoglobin (>12.7 g/dL), and higher albumin levels (>40.6 g/L) had the best survival. In contrast, subgroup 5 displayed a 20-fold risk of mortality (hazard ratio: 20.38 [95% CI: 10.78-38.52]); P < 0.001 and had older age (>68 years), low serum albumin (≤40.6 g/L), and higher NT-proBNP levels (≥9,750 pg/mL). Unique subgroups were further identified for each type of HF subtypes. ConclusionsSupervised machine learning reveals heterogeneity in the sMR risk spectrum, highlighting the clinical variability in the population. A decision tree–like model can help identify differences in outcomes among subgroups and can help provide tailored risk stratification.

Body mass index and serum markers associated with progression-free survival in lung cancer patients treated with immune checkpoint inhibitors

BackgroundICIs have remarkably affected the treatment strategies for numerous malignancies, including lung cancer. However, only a fraction of patients experience durable responses to ICIs; thus, there is an urgent need to identify the parameters related to ICI therapeutic effects. In this study, we investigated nutritional status surrogates and several serum markers to estimate the efficacy of ICIs.Materials and methodsThe records of 66 patients with stage III/IV lung cancer who received ICIs were retrospectively analyzed. Features of patients’ clinical pathology, including age, sex, histology, line of treatment, BMI, serum albumin, serum creatinine, and serum inflammatory markers such as LMR and PLR, were examined. Progression-free survival was the primary endpoint. Relationships among categorical variables were assessed by the chi-squared test. Survival analysis was performed using the Kaplan–Meier method followed by the log-rank test. Cox multivariate analysis was performed to analyze the association between each variable and the survival time of patients.ResultsThe patients with BMI ≥ 25 (kg/m2), serum ALB≥37 (g/dL), serum creatinine ≥61.8 (μmol/L), LMR ≥ 2.12 had a significantly prolonged PFS in comparison with BMI<25 (kg/m2), ALB<37 (g/dL), creatinine<61.8 (μmol/L), LMR<2.12 (p < 0.05). No statistically significant difference was detected between patients with PLR < 135 and PLR ≥ 135 (p = 0.612). Multivariate analysis revealed that ALB≥37 (g/dL) and creatinine ≥ 61.8 (μmol/L) were associated with prolonged PFS, while statistical significance was not achieved in the BMI groups.ConclusionsThe current results indicated that high BMI is related to longer PFS in lung cancer patients treated with ICIs, which may be correlated with high levels of serum albumin and creatinine.

Preoperative High Sleep Quality Predicts Further Decrease in Length of Stay after Total Joint Arthroplasty under Enhanced Recovery Short-stay Program: Experience in 604 Patients from a Single Team.

ObjectiveTo investigate the safety, efficiency and cost of total joint arthroplasty (TJA) under the enhanced recovery after surgery (ERAS) program and identify predictors facilitating further decrease in length of stay (LOS).MethodsWe retrospectively collected the information of patients who underwent primary unilateral TJA by a single surgical team between January 2017 and June 2019. A total of 604 patients with LOS ≤ 3 was enrolled in this study. All patients completed 12‐month or longer follow‐up. Patients received the same ERAS protocol, mainly including preoperative preparation (patient education, preoperative functional exercises, nutritional support), blood management, pain management, sleep management, prevention of infection, prevention of thrombosis and strict discharge criteria. Preoperative characteristics of patients were collected from the medical record system and were compared between the LOS ≤ 2 group and the LOS = 3 group. Factors with significant difference were included in multivariate logistic regression analysis to find independent preoperative predictors for LOS. Joint function at the latest follow‐up, adverse events rate and hospitalization costs were compared between the LOS ≤ 2 group and the LOS = 3 group.ResultsOf the enrolled 604 patients, 271 patients (44.9%) had a LOS of 2 days or less while 333 patients (55.1%) had a LOS of 3 days. Pittsburgh Sleep Quality Index score (odds ratio [OR] = 1.084, 95% confidence interval [CI] = 1.024–1.147, P = 0.005), preoperative albumin level (OR = 0.945, 95% CI = 0.905–0.988, P = 0.012), digestive diseases (OR = 1.084, 95% CI = 1.024–1.147, P = 0.005) and total hip arthroplasty (THA) (OR = 0.273, 95% CI = 0.170–0.439, P < 0.001) were predictors of LOS ≤ 2 in the multivariate logistic analysis model. The postoperative joint function scores and adverse event rates were comparable between the LOS ≤ 2 group and the LOS = 3 group. The hospital costs were lower in the LOS ≤ 2 group than the LOS = 3 group.ConclusionUnder the rigorous ERAS program, 2‐day discharge in unselected TJA patients can be routinely applied. Patients with high preoperative sleep quality, high preoperative albumin level, free of digestive disease and undergoing THA procedure are more likely to be discharged within 2 days.

Development of hand-food skin reaction correlates with prognosis of patients with HCC who were treated with sorafenib.

e16171 Background: Sorafenib is one of the effective systemic therapy in patient with advanced hepatocellular carcinoma (HCC). However, there are few prospective studies that have examined prognostic factors of sorafenib response. In this study, we analyzed prognostic factors of HCC patients who were treated with sorafenib. Methods: Between May 2016 and May 2018, 288 advanced HCC patients treated with sorafenib were enrolled at 13 hospitals. We analyzed possible prognostic factors of sorafenib response (overall survival and progression free survival) using Univariate and Multivariate analyses with Cox proportional hazards regression model. Results: Among the 288 patients, chronic hepatitis B (68.4%) was main cause in development of HCC. 85.4% of patients were in the advanced stage of Barcelona Clinic Liver Cancer. Hand-foot skin reactions (HFSR) were observed in 142 patients (49.2%). The univariate analysis identified presence of ascites, serum albumin level and creatinine level, presence of HFSR as potential prognostic factors for overall survival (OS). In multivariate analysis for OS, presence of HFSR (HR 0.144; 95% CI: 0.063-0.330, p 0.002), albumin level (HR ratio 0.283; 95% CI: 0.148-0.544, p &lt; 0.001), creatinine level (HR 1.395; 95% CI 1.133-1.717, p 0.002) were significant factors of OS. In univariate and multivariate analysis, presence of HFSR (HR 0.212; 95% CI: 0.091-0.495, p &lt; 0.001), and serum albumin level (HR 0.30, 95% CI: 0.158-0.568, p &lt; 0.001) were show significant correlation with progression free survival. Conclusions: Developing HFSR from sorafenib therapy and high serum albumin level were associated with improved OS and PFS. Developing HFSR have been suggested as possible predictor of good sorafenib response. Clinical trial information: NCT03212625.

Machine learning identifying peripheral circulating metabolites associated with intraocular pressure alterations

AimsTo identify blood metabolite markers associated with intraocular pressure (IOP) in a population-based cross-sectional study.MethodsThis study was conducted in a multiethnic Asian population (Chinese, n=2805; Indians, n=3045; Malays, n=3041 aged...

Sarcopenic Obesity Versus Nonobese Sarcopenia in Hemodialysis Patients: Differences in Nutritional Status, Quality of Life, and Clinical Outcomes

Sarcopenia and sarcopenic obesity (SO) are linked to unfavorable prognosis in maintenance hemodialysis (MHD) populations. We tested whether nonobese sarcopenia and SO, as different stages of extreme protein-energy wasting, have different prognoses. In this prospective observational study, 261 MHD patients were recruited from October 2010 to April 2012 and followed until October 2020. Two definitions were used to diagnose sarcopenia: the European Working Group on Sarcopenia in Older People consensus and the Foundation for the National Institutes of Health (FNIH) Biomarkers Consortium criteria. Obesity was determined as the percentage of total body fat, ≥27% for men and ≥38% for women. Data for all-cause and cardiovascular morbidity and mortality, baseline nutrition markers, inflammation and oxidative stress, adipokines, body composition parameters, handgrip strength, and quality of life (QoL) scores were measured. According to European Working Group on Sarcopenia in Older People, 115 (44.1%) patients were sarcopenic and 120 (46.0%) according to FNIH definitions. Of them, 28.4% and 34.5% were SO, respectively. Higher levels of albumin, creatinine, uric acid, leptin, phase angle, better nutritional scores, and lower adiponectin levels characterized SO patients compared with nonobese sarcopenic patients regardless of indexing method. Better QoL scores were noted in SO compared with nonobese sarcopenic patients using the FNIH sarcopenia criteria. The hazard of all-cause death, cardiovascular death, and first cardiovascular event for patients with SO was lower compared with the nonobese patients after multivariate adjustments. Statistical significance of these associations disappeared after including fat mass in multivariate models. MHD patients with SO have better nutritional status and prognosis for cardiovascular events, all-cause and cardiovascular disease mortality, and possibly better QoL compared with nonobese sarcopenic MHD patients. The better prognosis appears to be entirely due to the excess fat, which is protective in sarcopenic MHD patients similar to that described in the entire MHD population.

Characteristics of Kawasaki Disease Before and After the COVID-19 Pandemic in a Large Pediatric Heart Disease Center.

BackgroundKawasaki disease (KD) is an acute febrile systemic vasculitis of unknown etiology. After the pandemic of coronavirus disease 2019 (COVID-19), some children infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) showed clinical symptoms similar to KD, indicating a close relationship between KD and SARS-CoV-2. Therefore, we designed this retrospective study to analyze the characteristics of KD patients before and after the COVID-19 pandemic.MethodsWe retrospectively collected demographic and laboratory data of KD patients in Yuying Children's Hospital of Wenzhou Medical University from 1 January 2015 to 31 December 2020. Yuying Children's Hospital of Wenzhou Medical University is located in eastern China and is the largest pediatric heart disease center in the region, which includes a population of nearly 10 million. We studied the characteristics of KD patients and analyzed the changes in these characteristics before and after the emergence of SARS-CoV-2 in this area.ResultsThe analysis revealed the following novel features: (1) Under the influence of the COVID-19 pandemic, the onset age of Kawasaki disease became younger. (2) After the occurrence of COVID-19, the hospitalization days of KD patients were shorter than before the pandemic. (3) After the occurrence of COVID-19, the albumin of KD patients was higher than before the pandemic. (4) The COVID-19 pandemic did not have a significant effect on the incidence of coronary artery lesions (CALs) in Kawasaki disease.ConclusionAfter the COVID-19 outbreak, the characteristics of KD patients showed a younger trend of age, shorter hospitalization days and higher levels of albumin, but the incidence of CALs did not change significantly.

Clinical trial: intra dermal hepatitis B vaccination with topical imiquimod versus intra muscular hepatitis B vaccination in patients with inflammatory bowel disease.

Efficacy with conventional intra muscular (IM) hepatitis B vaccination in patients with inflammatory bowel disease (IBD) is suboptimal. To compare the immunogenicity of intradermal (ID) hepatitis B vaccination after topical imiquimod pre-treatment with IM hepatitis B vaccination in patients with IBD. Adult IBD patients with no evidence of hepatitis B infection or immunity (negative to HBsAg/anti-HBc/anti-HBs) were randomised 1:1 to receive either ID hepatitis B vaccine with topical imiquimod pre-treatment to injection site (ID-Imq) or IM hepatitis B vaccine with aqueous cream pre-treatment (IM-Aq) at 0, 1 and 6 months. Patients and investigators were blinded to the randomisation and intervention. The primary endpoint was seroprotection rate at 12-month, defined as percentage of subjects with anti-HBs ≥10 mIU/ml. Between September 2019 and December 2020, 104 patients with IBD (68% male; 50% Crohn's) enrolled, and 53 assigned to ID-Imq group. The percentage of patients using steroids, immunomodulators or biologics at randomisation was 15%, 55% or 22%, respectively. Seroprotection rate at 12 months was significantly higher in the ID-Imq group than the IM-Aq group (91% vs 69%; OR 4.39, 95% CI 1.47-13.11). Multivariate analysis showed that ID vaccine with topical imiquimod and higher albumin level were associated with a higher seroprotection rate. The safety profile was similar but local reactions were more common in the ID-Imq group. Intradermal hepatitis B vaccination with topical imiquimod pre-treatment is safe and offers superior seroprotection to conventional IM administration in patients with IBD.

MO855: Humoral Immunity Against Covid-19 6 Months After the Pfizer BNT162B2 Vaccine in Haemodialysis Patients: Data From 5 Dialysis Units. Is There a Role for HDF in the Covid-19 Pandemia?

Abstract BACKGROUND AND AIMS Haemodialysis (HD) patients tend to be old, have weakened immune systems and suffer from multiple comorbidities, making them particularly prone to infections and death by the Coronavirus disease 2019 (COVID-19). Global vaccination against SARS-CoV2 has been underway, but long-term data in dialysis patients are still scant. We aimed to study the seroconversion with the Pfizer BNT162b2 vaccine in HD patients of 5 Dialysis Centres after the first 2 doses and monitor the immune responses and clinical data during the following 7 months. We also investigated the security of the vaccine. METHOD We included 404 patients on chronic HD. All patients received 2 shots of the Pfizer BNT162b2 vaccine, separated by 21 days. Serologic tests were run using Quant II IgG anti-Spike SARS-CoV-2 assay by Abbott. Blood was drawn 21 days after the first dose (D22), 21 days after the second dose (D43), 3 and 6 months after the first dose (M3 and M6, respectively). We asked the patients to answer written questionaries about the symptoms reported during the 7 days after each vaccination. RESULTS 60.6% of our patients were male and the median age was 70 years (min 19, max 97). 26 patients (6.4%) had previously been infected with COVID-19. 6 of them (23.1%) needed hospitalization. At 7 months follow-up, there were 3 new cases and 1 death (the one who died had negative antibody counts at M3). Maximum response to the vaccine was seen at D43, with 97.3% of the patients showing positive antibody titers. At 6 months, 91.5% still had positive antibodies. As is reported in Table 1, the following patients had higher antibody titers at D43 and M6: patients with COVID-19 before the first vaccine, younger patients, patients with higher albumin levels, patients on HDF versus HD. Patients on HDF had higher titers at all moments during the 6 months (Figure 1). Patients with cancer without antineoplasic treatment in the last 6 months showed lower rates of seroconversion at D43: OR: 0.117 [95% confidence interval (95% CI) 0.016–0.863]} and M6 (OR: 0.203, 95% CI 0.049–0.842]. Patients whose levels of C-reactive protein was ≤ 2.8 mg/dL had more probability of seroconversion at D43 (OR: 7.840, 95% CI 1.839–33.419; P &amp;lt; 0.005) as well as those with a higher (better) Karnofsky scale (OR 1.062, 95% CI 1.016–1.110). 43.4% of the patients reported at least one side effect after the first shot and 64.6% after the second shot. A total of 69.1% had at least one-side effect on the first or second shot. All the reported reactions were mild and transitory. CONCLUSION Patients on HD respond surprisingly well to anti-COVID-19 vaccination and present only mild side effects. Further studies should analyze the impact of HDF on immune responses, since our work suggests that this type of dialysis may have a positive and protective long-term role on this population.

MO911: Prevalence of SARS-COV-2 Cellular and Humoral Immunity in Dialysis Patients After 8 Months of Vaccination Campaign in Portugal

BACKGROUND AND AIMSImmunization of dialysis dependent patients remains the single most important protective approach in prevention of serious COVID-19 infection. This study aims to characterize the prevalence of humoral and cellular immunity in maintenance dialysis patients (MDP) in a Nephrology Centre, 8 months after vaccination onset.METHODA single-center cross-sectional study enrolling patients on peritoneal (PD) and haemodialysis (HD) from a public-funded Portuguese Nephrology Centre. This study evaluated both humoral and cellular immunity to the COVID-19 vaccination. Humoral response was measured as specific IgG (S-RBD IgG), and cellular response as T-cell reactivity through IFN- γ quantification as response to antigen (IGRA). Further demographic and clinical variables were obtained to assess the risk factors of low immunity.RESULTSOf the 86 patients enrolled, 79.4% and 84.1% showed humoral and cellular immunity, respectively. Quantitatively, IgG S-RBD titers correlated with specific T-cell reactivity (ρ = 0.58, P < 0.001). Vaccination before dialysis initiation was associated with an absent cellular response (P = .006). Subgroup analysis associated high comorbidity burden (quantified through the Charlson comorbidity index) and low serum albumin levels as predictors of immunity (P < 0.05, variable). PD patients showed lower cellular response (297.1 mUI/mL versus 695.4 mUI/mL, P = 0.03) at 8 months following BNT162b2.CONCLUSIONThe prevalence of humoral and cellular immunity against SARS-CoV-2 in vaccinated Portuguese MDP is high. Vaccination in imminent pre-dialysis patients, high comorbidity burden and low serum albumin are some of the identified risk factors for absent immunity. PD-associated effector memory T-cell changes are suggested as contributing to the difference verified in cellular response.Table 1.Descriptive group and subgroup analysisComplete samplen = 88Subgroup An = 79Subgroup Bn = 68Age (years), mean (σ)69.9 (12.7)70.4 (12.5)70.2 (13.2)Sex (female/male), n (%)30 (34.1)29 (36.7)23 (33.8)Modality (HD/PD), n (%)67 (76.1)21 (23.9)60 (75.9)19 (24.1)49 (72.1)19 (27.9)Dialysis vintage at vaccination, months, mean (σ)-a-a29.7 (26.7)Diabetes, n (%)38 (43.2)35 (44.3)31 (45.6)Charlson comorbidity index, mean (σ)6.8 (2.5)6.8 (2.5)6.8 (2.5)Nephrosclerosis, n (%)24 (27.3)22 (27.8)18 (26.5)Immune disorders, n (%)7 (8)5 (6.3)2 (2.9)CKD stage at vaccination Maintenance dialysis, n (%) Stage 5 CKD, n (%) 79 (89.8)9 (10.2) 74 (14.8)5 (6.3) 68 (100)0Time from vaccination to immune status evaluation-8 monthsVaccineBNT162b2, n (%)ChAdOx1 nCov-19, n (%)Ad26.COV2.S, n (%)None, n (%) 78622 72520 68000Contact with SARS-CoV-2COVID-19 infection, n (%)Asymptomatic, n (%) 34 00 00Humoral responseIgG-RBD (AU/mL), median (IQR)NR, n (%) 4.6 (14)19 (21.6) 4.7 (12.8)16 (20.3) 4.6 (11.4)14 (20.6)Cellular responseIGRA (mUI/mL), median (IQR)NR, n (%) 574.8 (1376.9)14 (15.9) 571.8 (940.6)11 (13.9) 530 (914.9)10 (14.6)Laboratory variablesALB, mean (σ)iPTH, mean (σ)CRP, mean (σ) 3.5 (0.5)301.1 (317.7)1.1 (1.5) 3.6 (0.4)310.7 (318.2)1 (1.5) 3.6 (0.4)328.6 (331.5)1 (1.6)σ: standard deviation; CKD: chronic kidney disease; IQR: interquartile range; IGRA: interferon-γ release assay; NR: non-responsive; sALB: serum albumin; iPTH: intact parathormone; CRP: C-reactive protein. aBoth groups included patients who were not on dialysis.

Pre-operative Serum Albumin as a Potential Predictor of Benign Lesions in Renal Masses.

We investigated pre-operative factors for predicting whether renal masses are benign in order to facilitate the selection of optimal candidates for pre-operative biopsy. We evaluated 278 patients with renal masses suspected to be clinically T1 or T2 renal cell carcinoma. All patients had undergone a partial or radical nephrectomy. Pre-operative parameters, including patient characteristics, tumor size, and blood tests, were utilized to predict which lesions were benign. Twenty-five lesions (9.0%) were benign. Multivariate analysis showed that female sex [odds ratio (OR)=2.92, p=0.016], serum albumin ≥4.3 g/dl (OR=3.50, p=0.013), and tumor size <23 mm (OR=3.96, p=0.002) were significant independent factors for benign renal masses. The incidence of benign lesions in cases with all three factors (female sex, higher serum albumin, and smaller tumor size) was 4 of 16 (25.0%), which was significantly higher (p=0.037) than that in all cases (25/278; 9.0%). Relatively high pre-operative serum albumin levels may be a predictor of benign lesions when associated with female sex and smaller tumor size.

Baseline Total Metabolic Tumor Volume is Prognostic for Refractoriness to Immunochemotherapy in DLBCL: Results From GOYA

IntroductionA good response to initial therapy is key to maximizing survival in patients with diffuse large B-cell lymphoma (DLBCL), but patients with chemorefractory disease and early progression have poor outcomes. Patients and MethodsData from the GOYA study in patients with DLBCL who received first-line rituximab or obinutuzumab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) were analyzed. Positron emission tomography/computed tomography (PET/CT)-derived characteristics associated with total metabolic tumor volume (TMTV) and clinical risk factors for primary chemorefractory disease and disease progression within 12 months (POD12) were explored. ResultsOf those patients fulfilling the criteria for analysis, 108/1126 (10%) were primary chemorefractory and 147/1106 (13%) had POD12. Primary chemorefractory and POD12 status were strongly associated with reduced overall survival. After multivariable analysis of clinical and imaging-based risk factors by backward elimination, only very high TMTV (quartile [Q] 1 vs. Q4 odds ratio [OR]: 0.45; P = .006) and serum albumin levels (low vs. normal OR of 1.86; P = .004) were associated with primary chemorefractoriness. After additionally accounting for BCL2/MYC translocation in a subset of patients, TMTV and BCL2/MYC double-hit status remained as significant predictors of primary chemorefractoriness (Q1 vs. Q4 OR: 0.32, P = .01 and double-hit vs. no-hit OR of 4.47, P = .02, respectively). Risk factors including very high TMTV, high sum of the product of the longest diameters (SPD), geographic region (Asia), short time since diagnosis, extranodal involvement and low serum albumin were retained for POD12. ConclusionPET-derived TMTV has prognostic value in identifying patients at risk of early treatment failure.

Humoral antibody response to the first dose of the ChAdOx1 nCoV-19 vaccine in Asian patients undergoing hemodialysis.

Background and objectivesThe immunogenicity of vaccines is known to be attenuated in patients with end‐stage kidney disease due to uremia. Patients on dialysis were excluded from coronavirus disease 2019 (COVID‐19) vaccine trials; thus, the effectiveness of vaccines for this population is unclear. The aim of this study was to explore whether Asian dialysis patients can effectively produce an immune response after being vaccinated with the first dose of the ChAdOx1 nCoV‐19 vaccine.Design setting, participants, and measurementsIn this prospective cohort study, we included Asian hemodialysis patients who received the ChAdOx1 nCoV‐19 vaccine. At 3 weeks after the first dose of vaccination, we assessed the humoral immune response by measuring anti‐SARS‐CoV‐2 S antibody titers. The primary outcome was the seropositive rate following vaccination, defined as an antibody titer greater than or equal to 0.8 U/ml. Factors associated with seropositivity were explored in multivariate logistic regression analyses.ResultsIn total, 434 participants were included. The mean age was 64 years, the mean dialysis vintage was 6 years, and 61% of the participants were men. At a mean time of 22 days from vaccination, 56% of the participants were seropositive. The vast majority (88%) had low antibody titers (< 15 U/ml). The multivariate logistic regression analyses showed that older age (every increase of 10 years, odds ratio [OR] 0.80, 95% CI 0.65–0.98, p = 0.03) was negatively associated with seropositivity and that higher Kt/V (every increase of 0.1, OR 1.14, 95% CI 1.01–1.28, p = 0.03) and higher serum albumin level (every increase of 0.1 g/dl, OR 1.09, 95% CI 1.02–1.18, p = 0.02) were positively associated with seropositivity.ConclusionsIn Asian hemodialysis patients, the seropositive rate was low, and most had low antibody titers after the first dose of the ChAdOx1 nCoV‐19 vaccine. Younger age, better dialysis adequacy, and higher albumin levels were associated with seropositivity.

Prospective multicenter survey for Nursing and Healthcare-associated Pneumonia in Japan

IntroductionNursing and healthcare-associated pneumonia (NHCAP) was proposed by the Japanese Respiratory Society in 2011. However, the clinical characteristics of NHCAP are still unclear. Thus, this study aimed to clarify its clinical characteristics. MethodsThis multicenter prospective observational study included 596 patients with NHCAP from 73 centers in Japan between May 2014 and February 2016. ResultsPatient background was characterized by an older age (81.5 ± 10.1 years), most patients had complications (94.1%), and many patients had a high probability of aspiration pneumonia (68.6%). Among the isolates, Streptococcus pneumoniae was the most common (12.7%), while Pseudomonas aeruginosa was also isolated at 10.8%. The overall 30-day mortality rate for patients was 11.9%, and the factors affecting mortality were non-ambulatory status, high blood urea nitrogen level, impaired consciousness, and low albumin level. Sulbactam/ampicillin was the most commonly administered antibiotic, including in groups with high severity of illness and high risk of multidrug-resistant (MDR) pathogens. Both the A-DROP and I-ROAD scores were useful in predicting the prognosis of NHCAP. Confirmation of intention to provide do not attempt resuscitation (DNAR) instructions was given to 333 patients (55.9%), and 313 patients agreed to DNAR instructions. ConclusionsNHCAP tends to occur in elderly patients with underlying diseases. The risk of MDR pathogens and the mortality rate are intermediate for community-acquired pneumonia and hospital-acquired pneumonia. As NHCAP is considered an important concept in an aging society, such as in Japan, establishing a treatment strategy that considers not only prognosis but also quality of life would be beneficial.