High Risk Of Early Death Research Articles

Baseline laboratory tests as predictors of early death risk in 746 elderly oncologic patients: A prospective cohort study.

e23039 Background: The elderly population is the thoroughly affected by new cases of cancer, as well as by its complications. The occurrence of early death (in the first six months after diagnosis) is one of the most important outcomes to be studied in this population. This study aims to identify if simple baseline laboratory tests can be used as predictive factors for early death in older cancer patients. Methods: Prospective cohort enrolled elderly patients ≥ 60 years with a recent cancer diagnosis admitted between 2015 -2017. Sociodemographic, tumor-related and laboratorial (leukocytes, creatinine, platelets and hemoglobin) variables were collected at admission and analyzed. Survival analysis (Kaplan-Meier) and Cox proportional hazard regression was performed. The outcome was a six-month death. Descriptive, univariate and multivariate analysis of Cox proportional hazards and Kaplan-Meier global survival were performed. Results: A total of 746 patients with an average of 71 (± 7.4) years were eligible. 16.5% died in the first six months after diagnosis. Risk factors for early death were controlled by age. Leukocytes < 4,000 / mm3 or > 12,000 / mm3 (HR 2.51 IC95% 1.68-3.75), Creatinine > 1.7mg / dL (HR 2.14 95% CI 1.37-3.36), Platelets < 150,000 / mm3 or > 300,000 / mm3 (HR 1.92 CI 95% 1.31-2.80) and Hemoglobin < 12 g / dL if female, or < 13 g / dL, if male (HR 1.89 95% CI 1.27-2.83) were all associated with greater risk of dying in the first six months after diagnosis (log rank < 0.001). Conclusions: Baseline laboratory tests performed at the hospital admission of the elderly cancer patient may be a simple way to help the clinician to identify patients at higher risk of early death.

The comprehensive geriatric assessment in malignancies and prognostic factors: Description of a prospective cohort of 889 Brazilian elderly cancer patients.

e23035 Background: According to the World Health Organization (WHO), the definition of "elderly" varies according to the degree of development of the country. In Low and Medium Development Countries (LMDC), a person aged 60 or older is considered elder, opposed to developed countries (65 or older). It is in LMDC that is occurring the largest relative increase in the incidence of cancer, specially those related to aging. The Comprehensive Geriatric Assessment (CGA) is still underutilized in oncological clinical practice, especially in LMDC. Objectives: To determine predictive factors for the occurrence of early death (in the first six months of surveillance) and to perform the development and temporal validation of a practical prognostic score based on the CGA to predict early death (up to 180 days) in elderly cancer patients. Methods: A prospective cohort enrolled elderly patients ≥ 60 years with a recent cancer diagnosis admitted between 2015-2017. The CGA performed at the time of admission included the following instruments: CCI; KPS; MMSE; TUG test; IPAQ; ADL; MNA; MNA-SF; GDS15; PPS and Polypharmacy. The studied outcome was early death, defined as the one that occurred within the first six months after the diagnosis. Survival analysis (Kaplan-Meier) and Cox proportional hazard regression was performed. Results: 889 patients were included in the study, performed at a referral center in cancer of a teaching hospital in Northeastern Brazil. The independent risk factors for death identified by CGA were: Mini exam of mental state (MMSE) as a continuous variable (HR 1.04 95% CI 1.00-1.07), Geriatric depression scale (GDS-15) ≥ 10 (HR 1 , 50 IC95% 1.10-2.07), Karnofsky Functional Performance Scale (KPS) < 50 (HR 1.57 IC95% 1.02-2.42), Katz Index ≤4 (HR 2.58 IC95% 1.68-3.97) and the Mininutrition assessment (MAN-SF) < 12 (HR 2.96 IC95% 2.00-4.39), with higher risk for early death amongst patients with abnormalities detected by the scales performed at admission (log rank < 0.001). Conclusions: Comprehensive geriatric assessment is an important tool to identify fragility in elderly cancer patients. Some of its scales should be incorporated into clinical practice, as they are simple and significant prognostic markers and identify patients with a higher risk of death in the first twelve months.

Preoperative predictors of early death risk in bladder cancer patients treated with robot-assisted radical cystectomy.

BackgroundEarly identification of early death for bladder cancer patients undergoing radical cystectomy based on the laboratory findings at the time of diagnosis could improve the overall survival. The study aimed to explore preoperative factors associated with higher risk of early death (within 1 year after surgery) for bladder cancer patients.MethodsA total of 186 bladder cancer patients who underwent robot‐assisted radical cystectomy (RARC) were identified between October 2014 and May 2017. The probability of dying within 1 year after RARC was defined as the end point “early death.” Predictive factors including clinical features and laboratory findings at diagnosis were retrospectively collected.ResultsMedian follow‐up time after RARC was 20.6 months (1.2‐43.7 months). Fifty‐one patients (27.4%) died during follow‐up and 31 within 1 year from surgery (1‐year mortality rate: 16.7%). All potentially prognostic factors were assessed on univariate analyses, which revealed the following factors as being associated with higher risk of early death within 1 year after RARC: older age (P = 0.004), advanced clinical stage (P = 0.005), presence of hydronephrosis (P = 0.021), higher fibrinogen (P = 0.007), higher PLR (P = 0.031), and lower PNI (P = 0.016). In a multivariate Cox proportional hazard regression model analysis, age >60 years (HR = 7.303, 95% CI 1.734‐30.764; P = 0.007) and fibrinogen ≥3.295 g/L (HR = 2.396, 95% CI 1.138‐5.045; P = 0.007) at diagnosis were independent prognostic factors of early death after RARC.ConclusionAge and preoperative elevated plasma fibrinogen level were independent predictors for 1‐year mortality after RARC. We believe that plasma fibrinogen levels may become a useful biomarker, which may help guide the treatment decision‐making process for patients with bladder cancer.

Early Risks of Death, Stroke/Systemic Embolism, and Major Bleeding in Patients With Newly Diagnosed Atrial Fibrillation.

Atrial fibrillation is associated with increased risks of death, stroke/systemic embolism, and bleeding (incurred by antithrombotic therapy), which may occur early after diagnosis. We assessed the risk of early events (death, stroke/systemic embolism, and major bleeding) over 12 months and their relation to the time after diagnosis of atrial fibrillation in 52 014 patients prospectively enrolled in the GARFIELD-AF registry (Global Anticoagulant Registry in the FIELD-Atrial Fibrillation) between March 2010 and August 2016. Over 12 months, 2140 patients died (mortality rate, 4.3; 95% CI, 4.2-4.5 per 100 person-years), of whom 288 (13.5%) died in the first month (6.8; 95% CI, 6.1-7.6). Over 12 months, 657 patients had a stroke/systemic embolism (1.3; 95% CI, 1.2-1.4) and 411 had a major bleeding (0.8; 95% CI, 0.8-0.9). During the first month, the rates (per 100 person-years) of stroke/systemic embolism and major bleed were 2.3 (95% CI, 1.9-2.8) and 1.5 (95% CI, 1.2-1.9), respectively. The elevated 1-month mortality rate was mostly attributable to cardiovascular mortality (3.5; 95% CI, 3.0-4.1), in particular, heart failure, sudden death, and acute coronary syndromes (1.0 [95% CI, 0.8-1.4], 0.6 [95% CI, 0.4-0.8], and 0.5 [95% CI, 0.3-0.8], respectively). Age, heart failure, prior stroke, history of cirrhosis, vascular disease, moderate-to-severe kidney disease, diabetes mellitus, and living in North or Latin America were independent predictors of a higher risk of early death, whereas anticoagulation and living in Europe or Asia were independent predictors of a lower risk of early death. A predictive model developed for the 1-month risk of death had a C-statistic of 0.81 (95% CI, 0.78-0.83). The increased hazard of early events, in particular, cardiovascular mortality, in newly diagnosed atrial fibrillation points to the importance of comprehensive care for such patients and should alert clinicians to detect warning signs of possible early mortality. URL: https://www.clinicaltrials.gov . Unique identifier: NCT01090362.

Deaths by Suicide and Other Causes Among Patients With Borderline Personality Disorder and Personality-Disordered Comparison Subjects Over 24 Years of Prospective Follow-Up.

This study has 4 aims. The first is to determine rates of mortality due to suicide and other causes for patients with borderline personality disorder (BPD) and personality-disordered comparison subjects over 24 years of prospective follow-up. The second and third aims are to determine the best predictors of time-to-suicide and time-to-premature death (not due to suicide) in patients with BPD. A final aim is to determine whether mortality rates are impacted by recovery status. A total of 290 adult inpatients meeting rigorous Revised Diagnostic Interview for Borderlines and DSM-III-R criteria for BPD and 72 personality-disordered comparison subjects were recruited during inpatient admission at McLean Hospital between June 1992 and December 1995. Participants were followed and reassessed every 2 years, with data collection now entering its 26th year. Participant deaths were tracked over time. A total of 5.9% of borderline patients and 1.4% of comparison subjects died by suicide. Additionally, 14.0% of borderline patients and 5.5% of comparison subjects died by non-suicide causes. Among borderline patients, number of prior hospitalizations significantly predicted completed suicide (HR = 1.62, P = .037). Sociodemographic factors, physical health indicators, and psychiatric history significantly predicted premature death (not due to suicide) in bivariate analyses (all P values < .05). In multivariate analyses, male sex (HR = 3.56, P = .003) and more prior psychiatric hospitalizations (HR = 2.93, P < .001) significantly predicted premature death. Most borderline patients who died either by suicide (87.5%) or non-suicide-related causes (88%) were not recovered before death. Taken together, these findings suggest that individuals with BPD are at elevated risk of premature death. Patients who did not achieve recovery were at a disproportionately higher risk of early death than recovered patients.

T cell Co-Stimulatory molecules ICOS and CD28 stratify idiopathic pulmonary fibrosis survival

Idiopathic pulmonary fibrosis (IPF) is a devastating disease that kills as many Americans as breast cancer each year. This study investigated whether lung function decline and survival associates with adaptive immunity in patients with IPF, specifically the expression of checkpoint molecules ICOS, CD28 and PD-1 on circulating CD4 T cells. Clinical data, blood samples and pulmonary function tests were collected prospectively and longitudinally from 59 patients with IPF over a study period of 5 years. Patients were followed until death, lung transplantation, or study end, and cell surface expression of CD45RO, CD28, ICOS, and PD-1 was measured on CD4 T cells via flow cytometry. Repeated measures of ICOS and CD28 on CD4 T cells revealed significant associations between declining ICOS and CD28 expression, and declining lung function parameters FVC and DLCO, independent of age, sex, race, smoking history, or immunosuppressant use. Strikingly, patients in the highest quintile of ICOS at study entry had markedly improved survival, while those with low CD28 fared poorly. No change in PD-1 expression was found. Analysis of ICOS and CD28 from the first blood draw identified three populations of IPF patients; those at high risk for early death, those with intermediate risk, and those at low risk. These results highlight the role of T cell mediated immunity in IPF survival, finding the assessment of two T cell stimulatory checkpoint molecules, CD28 and ICOS, was sufficient to discriminate three distinct survival trajectories over 5 years of patient follow up.

Appraisal of Basic-Hemostatic Markers in Lung Cancer Patients During Follow-Up Care After Radiotherapy Treatment.

BackgroundThe aim of this paper was to investigate the association between clinicopathological factors and the coagulation test in lung cancer patients during follow-up care after treatment.Material/MethodsNinety-five medical patients with histologically proven advanced lung carcinoma (LC) who had undergone radiotherapy were prospectively reviewed between January 2014 and December 2016. The study investigated the relationship between the biochemical results, the disease stage, and the survival rate in lung cancer patients. Post-treatment coagulation-based D-dimer (DD), fibrinogen (Fib), and complete blood count (CBC) were evaluated during the follow-up over a period of 2 years after treatment or until the patient’s death.ResultsAn increase of D-dimer generates an increased chance of early death by approximately 0.03% per 1 D-dimer unit. In cases when the difference in the D-dimer concentration equals 1000, the risk of an early death increases by (1.00031000−1)×100%=35%.ConclusionsHigh levels of D-dimer are associated with an advanced form of disease with metastasis and higher risk of early death in lung cancer patients.

Thrombolytic and Anticoagulant Therapy for Pulmonary Embolism with High and Intermendiate Risk of Early Death. Part 3. An Effect on Pulmonary Perfusion with High and Intermediate Risk of Early Death

Background The advantage of thrombolytic therapy (TLT) over anticoagulant therapy(ACT) in patients with a high risk of early death (hemodynamic disorders) in acute pulmonary embolism is considered proven. But the advantage of thrombolytic therapy over anticoagulant therapy remains uncertain in patients with an intermediate risk. Perfusion lung scintigraphy helps provide a quantitative comparison of changes in pulmonary blood flow with the use of different treatment methods in subgroups of high and intermediate risk of an adverse outcome.The aim of study is to compare the effectiveness of thrombolytic and anticoagulant therapy in the treatment of acute pulmonary embolism in patients with a high and intermediate risk of early death in terms of the dynamics of pulmonary perfusion disorders.Study design: a prospective non-randomized study. The introduction of a thrombolytic was cosidered as intervention. The comparison group consisted of patients who received an anticoagulant. Thrombolysis in patients with intermediate risk was indicated in the absence of a potential threat of hemorrhagic complications, a deficit of pulmonary perfusion above 40%, a high level of pulmonary hypertension and a high probability of cardiac decompensation. The method of comparison was the quantitative result of pulmonary perfusion deficiency.Description of the method Radionuclide and CT studies were carried out using a hybrid system SPECT/CT Discovery NM/CT 670 (GE, USA): the perfusion was evaluated with 80–120 MBq of 99mTc macrotech radiopharmaceutical (RP) (effective equivalent dose of 0.8–1.3 mSv), CT angiography was performed with 70–100 ml of radiopaque substance Visipaque (effective equivalent dose of irradiation 9.4–10.3 mSv). The accumulation deficit of an area equal to a segment was counted as a perfusion deficiency of 5% (subsegmental 2.5%), inferior lobe — 25%, an area equal to the right lung — 55%, the left lung — 45%.Characteristics of the sample In a sample of 503 patients who received treatment at the Intensive Care Unit for Surgical Patients of the N.V. Sklifosovsky Institute for Emergency Medicine from 2011 to 2016, the overall mortality rate was 14.7% (95% CI 11.7; 18.1) (74/503); anticoagulation therapy — 17.8% (95% CI 13.5; 22.8) (50/281); thrombolytic therapy — 10.8% (95% CI 7.1; 15.6) (24/222); p=0.031, Fisher’s test, P=0.60. At a high risk of death, the mortality rate in the thrombolytic therapy group was 30.2% (19/63) versus 47.1% (32/68) in the anticoagulant therapy group; p=0.051, the Fisher’s test; P=0.51. At an intermediate risk, it was 3.2% (5/158) and 8.4% (8/214); p=0.049, the Fisher’s test, P=0.54. Changes in pulmonary perfusion deficiency as a result of treatment were performed in 169 patients who promptly underwent a primary and repeated dynamic scintigraphic study: 127 patients after thrombolysis (of which 38 patients had a high risk and 88 had an intermediate risk) and 42 patients who were treated with an anticoagulant (5 — high risk, 37 — intermediate risk). The groups did not differ in age and gender composition: the mean age was 59±16; Me 61 (49; 71) and 57±14 years; Me 58 (43; 67), respectively; p=0.50 (Mann–Whitney test); men/women: 50/77 and 12/30; p=0.27, the Fisher’s test. The groups differed in the presence of cancer: in the ACT group, the proportion of patients with cancer was 21.4% (9/42), and in the TLT group it was 4.7% (6/127), p=0.003, the Fisher’s test, P=0.85.Results Patients of high and intermediate risk, who received thrombolysis, were in a significantly more serious condition in terms of baseline characteristics. Both methods of treatment were effective. In high-risk patients, perfusion deficiency regressed: from 57±10% (Me 60 (50; 65)) to 31±15% (Me 30 (20; 40)), p&lt;0.00001 (Wilcoxon test), Es=2.08, P=1.00 after TLT; from 38±9% (Me 40 (35; 40)) to 14±8% (Me 10 (10; 20)), p=0.043 (Wilcoxon test), Es=2.72, P=0.93 after ACT. In patients with intermediate risk, perfusion deficiency regressed: from 48±9% (Me 50 (40, 55)) to 24±13% (Me 20 (15; 30)), p&lt;0.00001 (Wilcoxon test) after TLT; from 38±11% (Me 40 (30; 45)) to 24±15% (Me 15 (15; 30)), p=0.00003 (Wilcoxon test) after ACT. The effect size for TLT was Es=2.16, for ACT Es=1.13. The power of the study was P=1.00 and P=0.99.Conclusion Thrombolytic therapy was more effective in restoring pulmonary perfusion compared to anticoagulants in patients with an intermediate risk of early death: the effect of thrombolysis was greater than that of anticoagulant therapy (Es=2.16 and Es=1.13). The absence of the effect of restoring pulmonary perfusion during thrombolysis was noted less frequently compared to the results of anticoagulant therapy: in 5.5% (95% CI 2.2–11.0) vs. 19.0% (95% CI 8.6–34.1).

Peer support and mobile health technology targeting obesity-related cardiovascular risk in young adults with serious mental illness: Protocol for a randomized controlled trial

BackgroundIndividuals with serious mental illness (SMI) such as schizophrenia and bipolar disorder face a higher risk of early death due to cardiovascular disease and other preventable chronic illnesses. Young adulthood is a critical window of development for lifestyle interventions to improve the long-term health and quality of life in this population. Fit Forward is an NIH-funded randomized clinical trial examining the effectiveness of a group lifestyle intervention (PeerFIT) enhanced with mobile health technology compared to one-on-one mobile lifestyle coaching with Basic Education in fitness and nutrition supported by a wearable Activity Tracking device (BEAT) in achieving clinically significant weight loss and improved cardiorespiratory fitness in young adults with SMI. MethodsFit Forward targets 144 young adults (18 to 35 years) with SMI and a body mass index (BMI) of ≥25 receiving public mental health services. In a two-arm randomized clinical trial, participants will be randomly assigned with equal probability to PeerFIT or BEAT, stratified by birth sex and psychiatric diagnosis. Participants will be assessed at baseline, 6, and 12 months. The primary outcome is cardiovascular risk reduction indicated by either clinically significant weight loss (5% or greater) or increased fitness (>50 m on the 6-Minute Walk Test). Secondary outcomes include change in BMI, lipids, and hemoglobin A1c. Perceived self-efficacy for exercise and peer support will be evaluated as mechanisms underlying intervention effects. ConclusionIf effective, PeerFIT will provide a potentially scalable approach to addressing health risks among young adults with SMI in mental health settings. Trials registrationClinicalTrials.gov, NCT02815813.

Prise en charge et pronostic des embolies pulmonaires associées à des thrombi intracavitaires droits : à propos d’une série prospective au centre Hospitalier Universitaire Yalgado Ouédraogo

ObjectiveTo describe the management and evolution of high risk of death pulmonary embolism associated with right heart thrombi. Material and methodsWe conducted a prospective cohort survey over a 54 month-period, from March 1st, 2012 to September 30th 2015. Were included all patients with pulmonary embolism and having high or intermediate-high risk of death. Patients were divided into two groups according to whether cardiac Doppler-echography found a thrombus in the right chambers or not (ICT+ vs. ICT−). The survival curves for the patients were obtained using the software STATA. ResultsThe prevalence of pulmonary embolism associated with right heart thrombi was 4% in our study. Thrombi were mobile, straight localization in all cases. The ICT+group was characterized by a significantly higher proportion of congestive heart and chronic lung disease. The proportion of patients’ thrombolysis was significantly higher in the ICT-group. In the ICT+group, thrombolysis significantly reduced mortality giving a 30-day survival of 80% against 20% among patients receiving only heparin. ConclusionPulmonary embolism associated with right heart thrombi including the atrium are not exceptional. These patients are at high risk of early death. Thrombolysis is significantly improving the mortality of pulmonary embolism associated with right-sided heart thrombi.

Development of a risk grading system to identify patients with acute promyelocytic leukemia at high risk of early death.

BackgroundEarly death (ED) rate in acute promyelocytic leukemia (APL) remains high. Some studies have identified prognostic factors capable of predicting ED, whereas no risk rating system for ED has been reported in the literature. In this study, a risk classification system was built to identify subgroup at high risk of ED among patients with APL.MethodsTotally, 364 consecutive APL patients who received arsenic trioxide as induction therapy were included. Ten baseline clinical characteristics were selected for analysis, and they were de novo/relapse, age, sex, white blood cell count, platelet count, serum fibrinogen, creatinine, uric acid, aspartate aminotransferase, and albumin. Using a training cohort (N=275), a multivariable logistic regression model was constructed, which was internally validated by the bootstrap method and externally validated using an independent cohort (N=89). Based on the model, a risk classification system was designed. Then, all patients were regrouped into de novo (N=285) and relapse (N=79) cohorts and the model and risk classification system were applied to both cohorts.ResultsThe constructed model included 8 variables without platelet count and sex. The model had excellent discriminatory ability (optimism-corrected area under the receiver operator characteristic curve=0.816±0.028 in the training cohort and area under the receiver operator characteristic curve=0.798 in the independent cohort) and fit well for both the training and independent data sets (Hosmer–Lemeshow test, P=0.718 and 0.25, respectively). The optimism-corrected calibration slope was 0.817±0.12. The risk classification system could identify a subgroup comprising ~25% of patients at high risk of ED in both the training and independent cohorts (OR=0.140, P<0.001 and OR=0.224, P=0.027, respectively). The risk classification system could effectively identify patient subgroups at high risk of ED in not only de novo but also relapse cohorts (OR=0.233, P<0.001 and OR=0.105, P=0.001, respectively).ConclusionAll the results highlight the high practical value of the risk classification system.

Factors Affecting Early Death and Survival of Patients With Acute Promyelocytic Leukemia Treated With ATRA-Based Therapy Regimens

PurposeTo perform a retrospective analysis of the prognostic relevance of clinicopathologic parameters in a well-documented cohort of patients treated with all-trans-retinoic acid (ATRA)-based induction regimens in order to discover which indicators can predict a high risk of early death (ED) and patient survival. Patients and MethodsWe analyzed data of 288 newly diagnosed adult acute promyelocytic leukemia patients in Hangzhou, China. The median follow-up time was 32 months (range, 6-78 months). ResultsThe 3-year disease-free and overall survival rates were 90.83% and 91.69%, respectively. In the multivariable analysis, older age (≥ 60 years) was the only independent risk factor for ED (hazard ratio [HR] = 15.057; P = .004). High white blood cell count was not a risk factor for ED (P = .055), but it was for relapse (HR = 2.7; P = .009). FLT3 mutation (HR = 3.9; 95% confidence interval, 1.4 to 10; P = .007) and older age (≥ 60 years) (HR = 5.3; 95% confidence interval, 2.4 to 11; P < .001) were prognostic factors for poorer disease-free and overall survival. Interestingly, CD15 negativity (HR = 0.23; P = .049) was a prognostic factor for relapse. The ED rate was 5.9% (17/288 patients). ConclusionThe perceived impact of the identification of these high-risk factors should be described in order to decide whether any modifications to treatment strategy should be entertained.

Abstract 4623: Meta-analysis of transcriptomic profiles identifies prognostic model for pancreatic ductal adenocarcinoma patients

Abstract Purpose The main objective was to develop a robust molecular predictor model with high prognostic value across multiple independent cohorts of pancreatic ductal adenocarcinoma (PDAC) patients using a novel meta-analysis framework. The median 5-year overall survival (OS) of PDAC patient is &amp;lt;8%. Only 10-20% of patients are eligible for surgery, and of these, more than half will die within a year of surgery. The identification of a biologically relevant molecular predictor model is urgently needed to define strategies that may help patient selection at high risk of early death to inform treatment decisions. Methods We developed the Pancreatic Cancer Overall Survival Predictor (PCOSP), a new prognostic model built from a unique set 89 PDAC patients whose gene expressions have been profiled using both microarray and sequencing platforms. We used the recent binary gene pair method to create gene expression barcodes robust to biases arising from heterogeneous profiling platforms and batch effects. Leveraging the largest compendium of PDAC transcriptomic datasets to date, including 1,198 patients, we show that PCOSP is a robust single-sample predictor of early death (≤1 yr) after surgery in a subset of 823 validation samples with available trancriptomics and survival data. Results The PCOSP model was strongly and significantly prognostic overall with a meta-estimate of the area under the ROC curve of 0.70 (P=1.9e-18) and hazard ratio of 1.95 (P=2.6e-16) for binary and survival predictions, respectively. The prognostic value of PCOSP was independent of clinicopathological parameters and molecular subtypes. The PCOSP model includes 2,619 gene pairs, with 1,070 unique genes. Over-representation analysis of these genes unveiled pathways associated with Hedgehog signalling, epithelial mesenchymal transition (EMT) and extracellular matrix (ECM) signalling at FDR&amp;lt;0.05. Conclusions This study reports a PCOSP model to predict post-operative OS independently of clinicopathological features. This may assist clinicians in making decisions that would ultimately improve the OS and facilitate decisions concerning a surgery-first versus a neoadjuvant approach. The functional analysis of the PCOSP genes may give further insight to tumor biology of short-term survival PDAC patients. Citation Format: Vandana Sandhu, Knut Jorgen Labori, Ayelet Borgida, Ilinca Lungu, John Bartlett, Sara Hafezi-Bakhtiari, Rob Denroche, Gun Ho Jang, Danielle Pasternack, Faridah Mbaabali, Matthew Watson, Julie Wilson, Elin H. Kure, Steven Gallinger, Benjamin Haibe-Kains. Meta-analysis of transcriptomic profiles identifies prognostic model for pancreatic ductal adenocarcinoma patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4623.

Risk Factors for Early Mortality in Liver Transplant Patients

BackgroundLiver transplantation (LT) is an established treatment for patients with end-stage liver disease. The significant advances in surgical technique, immunosuppression therapy, and anesthesiological management have dramatically improved short- and long-term outcomes. The aim of this study is to correlate specific surgical and anesthesiological variables with causes of early death in LT recipients. MethodsA retrospective observational analysis of adult patients who underwent LT in the period 2012 to 2016 and died within 90 days following LT was conducted. Exclusion criteria were intraoperative death, split liver, and domino transplant. Death was considered a dependent variable and classified into 3 different groups: death by sepsis, vascular events not related to the graft, and primary non-function. Donor and recipient variables were considered and analyzed using Fisher's exact test. ResultsStatistically significative associations (P value < .05) were found between renal function support, retransplantation, and the number of fresh frozen plasma units transfused in one group and early death due to sepsis in the other. ConclusionsThis study identified some risk factors associated with the specific cause of early death in liver transplantation. The clinical implications of these findings are the ability to stratify patients at high risk of early death by planning more intensive and accurate management for them.

Risk factors for early death in primary malignant cardiac tumors: An analysis of over 40 years and 500 patients

ObjectivesTo investigate risk factors contributing to early death in patients diagnosed with primary malignant cardiac tumors (PMCTs) and derive better understanding of these poorly characterized individuals. MethodData from the Surveillance, Epidemiology and End-Results (SEER) registries on 564 patients diagnosed with PMCTs between 1973 and 2014 were analyzed. Early death was defined as survival of ≤3 months from the time of diagnosis. Two-tailed χ2 or fisher's exact test were used for association between categorical variables and occurrence of early death. Logistic regression analysis was used to assess independent risk factors of early death. Time trends in early death rates of PMCTs were described using scatter plot. ResultsOf the 564 patients with PMCTs, early death was identified in 214 individuals (37.9%). Patients with unspecified soft tissue sarcomas and blood vessel tumors had the highest risk of early death. Age > 80 years and non-consent for surgery were strong predictors of early death in all PMCT subtypes. In sarcomas, disadvantaged income was associated with an increase in early mortality, while black race was associated with a reduction in early mortality. In mesotheliomas and others, male sex was a risk factor for early mortality, while Hispanic ethnicity was associated with a reduction in early mortality. Percentages of early death slightly decreased over the past 40 years. ConclusionsPredictors of early death are primarily related to age older than 80 years, no surgery and specific histopathology types but also include disadvantaged socioeconomic status and male sex. Initiatives to identify those at risk and develop preventive interventions should be prioritized.

Growth differentiation factor-15 is a new biomarker for survival and renal outcomes in light chain amyloidosis

AbstractGrowth differentiation factor-15 (GDF-15) improves prognostication in patients with cardiovascular disorders in addition to conventional cardiac markers (N-terminal pro B-type natriuretic peptide [NT-proBNP], troponins [Tns]) and has shown prognostic value in patients with renal diseases. In patients with light chain (AL) amyloidosis, cardiac involvement is the major determinant of prognosis, and cardiac markers define prognosis, whereas biomarkers of renal involvement stratify renal risk. We explored the prognostic importance of serum level of GDF-15 in patients with AL amyloidosis in 2 independent cohorts. The prognostic value of GDF-15 level was initially evaluated in a cohort of 107 consecutive previously untreated patients with AL amyloidosis from Athens, Greece, and was then validated in a second cohort of 202 consecutive previously untreated patients from Pavia, Italy. High GDF-15 level was associated with a higher risk of early death and poor overall survival independently of NT-proBNP and high-sensitivity TnT (hsTnT) or hsTnI levels. At the 6-month landmark, reduction of GDF-15 level ≥25% was associated with improved outcome. GDF-15 level ≥4000 pg/mL was associated with a high risk of progression to dialysis, independently of renal risk defined by estimated glomerular filtration rate and proteinuria, in both cohorts; failure to reduce GDF-15 below this level was associated with increased risk at either the 3- or 6-month landmark, independently of the established renal response or progression criteria. In conclusion, GDF-15 has prognostic implications for different outcomes in patients with AL and adds prognostic information independent of that provided by cardiac and renal risk biomarkers.

Early myeloma-related death in elderly patients: development of a clinical prognostic score and evaluation of response sustainability role.

Although survival of elderly myeloma patients has significantly improved there is still a subset of patients who, despite being fit and achieving optimal responses, will die within 2 years of diagnosis due to myeloma progression. The objective of this study was to define a scoring prognostic index to identify this group of patients. We have evaluated the outcome of 490 newly diagnosed elderly myeloma patients included in two Spanish trials (GEM2005-GEM2010). Sixty-eight patients (13.8%) died within 2 years of diagnosis (early deaths) due to myeloma progression. Our study shows that the use of simple scoring model based on 4 widely available markers(elevated LDH, ISS 3, high risk CA or >75 years) can contribute to identify up-front these patients. Moreover, unsustained response (<6 months duration) emerged as one important predictor of early myeloma-related mortality associated with a significant increase in the risk of death related to myeloma progression. The identification of these patients at high risk of early death is relevant for innovative trials aiming to maintain the depth of first response, since many of them will not receive subsequent lines of therapy.

Prognostic significance of electrocardiogram at presentation in patients with pulmonary embolism of different severity

BackgroundSeveral electrocardiographic (ECG) abnormalities have been described in patients with acute pulmonary embolism (PE), with discordant reportings about their prognostic value. MethodsConsecutive patients with echocardiography performed within 48 h from admission and ECG at presentation, were included in this analysis. The primary study outcome was in-hospital death for high-risk patients and in-hospital death or clinical deterioration for intermediate-risk patients. As secondary outcomes, the associations among ECG abnormalities and both right ventricular dysfunction at echocardiography and baseline troponin elevation were considered. Results1194 patients were included in this analysis: 13.8% of patients were at high risk of early death, 61.7% were at intermediate risk and 24.5% were at low risk. ECG signs of RV strain showed a continuously decreasing prevalence from high-risk to intermediate-risk and low-risk patients. Differently, the prevalence of T- wave inversion was similar in high and intermediate-risk patients. In high-risk-patients, Qr pattern in lead V1 was the only ECG abnormality associated with in-hospital mortality, but this sign was detected in only 15.9% of this risk category; the presence of at least one ECG abnormality was not associated with the risk of in-hospital death. In not high-risk patients, the presence of at least one ECG abnormality was significantly associated with RVD and this association was confirmed for each individual ECG abnormality. Similar results were obtained as regards the baseline troponin elevation in 816 patients. ConclusionsAmong the electrocardiographic signs of RV strain/ischemia, Qr pattern in lead V1 was the only ECG abnormality associated with in-hospital mortality in high-risk patients. In not high-risk patients the demonstrated association among baseline ECG signs of RV strain/ischemia and RV dysfunction at echocardiography or troponin elevation highlights the need for early further investigations in patients with such ECG abnormalities.

Evaluation of the Safety and Clinical Effectiveness of Endovascular Mechanical Fragmentation with Local Thrombolysis in the Patients Presenting with Pulmonary Embolism at Intermediate and High Risk of Early Death

Evaluation of the Safety and Clinical Effectiveness of Endovascular Mechanical Fragmentation with Local Thrombolysis in the Patients Presenting with Pulmonary Embolism at Intermediate and High Risk of Early Death

Vasopressor Cumulative Dose Requirement and Risk of Early Death During Septic Shock: An Analysis From The EPISS Cohort.

Septic shock is the primary cause of death in intensive care units, with about 20% of patients dying in the first 3 days. To design future trials focused on early mortality, we require knowledge of early indicators that can detect patients at high risk of early death from refractory septic shock. The aim of this study was to assess whether the cumulative dose of vasopressors (CDV), calculated as the cumulative dose of epinephrine + norepinephrine, is a predictor of early death (within 72 h) attributable to refractory septic shock (EDASS). This substudy of the EPISS trial was based on 370 patients admitted to a French ICU for septic shock between 2009 and 2011. The area under the receiving operating characteristic curve was calculated for the CDV at 6, 12, 24, 36, and 48 h after vasopressor initiation, and a strategy to predict the risk of EDASS was built based on selected times and thresholds. Among the 370 patients included, 51 (14%) died within the first 72 h with 40 (11%) EDASS. A strategy in two steps (CDV ≥ 800 μg/kg at 6 h and/or CDV ≥ 2,600 μg/kg at 24 h) was able to predict EDASS with sensitivity of 45%, specificity 97%, positive predictive value 78% and negative predictive value 94%. Overall, our results confirm that early death directly attributable to septic shock could be effectively predicted by the CDV in the first hours of treatment. These results will help to select patients eligible for innovative therapies aimed at improving early mortality in septic shock.