Impact Of Neurological Complications Research Articles

Early neurologic complications after liver transplant are associated with reduced long-term survival and increased rates of rejection.

Neurologic complications (NCs) are common following liver transplantation (LT) and have been associated with impaired short-term survival. The impact of NC on long-term survival is less defined. We aimed to characterize these outcomes and assess for risk factors for post-LT NC. We performed a single-center, retrospective review of 521 patients with LT from 2016 to 2020. Baseline clinical and laboratory factors, intraoperative events, and outcomes were compared between patients with and without NC. The 5-year overall and rejection-free survival was estimated using the Kaplan-Meier analysis. Multivariable logistic regression assessed for an independent relationship between risk factors and the development of NC. Among 521 LT recipients, 24% experienced post-LT NC. Overall and rejection-free survival at 5 years was, respectively, 69% and 75% among those with NC versus 87% and 88% among those without NC (log-rank < 0.001). Among those who survived the first 3 months after LT, overall survival but not rejection-free survival was reduced among patients with NC. Risk factors for developing NC included peri-LT serum sodium (ΔSNa) ≥ 6 (29.4% vs. 20.5%, p = 0.04), grade 3 or 4 HE pre-LT, SNa < 125 pre-LT, and more intraoperative transfusions. In a multivariable logistic regression model controlling for described variables, SNa < 125 (or 0.21, 95% CI, 0.06-0.74) at LT and pre-LT HE grade 3 or 4 (or 0.45, 95% CI, 0.26-0.76) was independently associated with NC. Long-term survival was reduced among patients who developed NC in the immediate post-transplant period, even when censoring those who died in the first 3 months. Post-LT NC was associated with perioperative ΔSNa ≥ 6. Optimization of SNa pre-LT > 125 and limiting perioperative ΔSNa <6 mEq/L might have a beneficial impact in decreasing NC post-LT, which may improve long-term post-LT survival.

Impact of Neurological Complications on QoL in Sjögren’s Patients (P9-5.019)

<h3>Objective:</h3> To understand the occurrence of neurological disease manifestations and their impact on QoL in a Sjögren’s population. <h3>Background:</h3> Sjögren’s is a serious and systemic autoimmune disease that affects the entire body, including the nervous system. <h3>Design/Methods:</h3> An online survey was administered October–November 2021 to U.S.-based Sjögren’s patients aged ≥18 years. <h3>Results:</h3> Of the total respondents (n=3,622), 83% reported having been diagnosed with ≥1 nervous system related condition. The most common diagnoses were anxiety/depression (50%), brain fog (47%), and neuropathy (45%). More than half of the respondents reported experiencing brain fog (80%), trouble sleeping (73%), anxiety (66%), forgetfulness (64%), neuropathy (64%), and headache (56%) during the prior year. A majority of respondents experienced a major or moderate negative impact related to each of these symptoms (range: 58%–88%). Five of the top 10 symptoms with the greatest negative impact were related to the nervous system. Notable differences were found between those without a reported neurological condition versus those with ≥1 neurological conditions in the negative impact experienced related to their ability to exercise, participate in social activities, be independent, their overall mood, and when performing activities of daily living (OR Ranges: 1 neurological condition, 1.96–2.35; ≥5 conditions, 11.46–17.78). Respondents with neurological conditions were more likely to state that they did not feel they were living a fulfilling life (1, OR 1.67; ≥5, 6.88). Respondents expressed a critical need for new therapies to address a range of nervous-system related issues, including sleep problems (77%), brain fog/forgetfulness (77%), and neuropathy (68%). <h3>Conclusions:</h3> Neurological disease manifestations frequently occur in Sjögren’s patients and have a major impact on QoL. The presence of multiple neurological conditions was associated with worsening QoL in a variety of factors. Because of its multifactorial nature, fatigue was not included in this analysis, though it remains one of the biggest issues for Sjögren’s patients. <b>Disclosure:</b> Mr. Makara has received personal compensation for serving as an employee of the Sjogren’s Foundation . Ms. Hammitt has received personal compensation for serving as an employee of Sjogren’s Foundation. Dr. Destro has received personal compensation for serving as an employee of Sjogren’s Foundation . Ms. Church has received personal compensation for serving as an employee of Sjogren’s Foundation, Inc..

Neurologic complications after allogeneic hematopoietic stem cell transplantation: risk factors and impact.

Neurologic complications (NCs) may be a significant source of morbidity and mortality after hematopoietic cell transplantation (HCT). We performed a retrospective study of 263 consecutive patients undergoing allogeneic HCT for hematological malignancies to determine the incidence, risk factors and clinical impact of NCs in the first 5 years after HCT. We determined the incidence of central nervous system (CNS) infection, intracranial hemorrhage, ischemic stroke, metabolic encephalopathy, posterior reversal encephalopathy syndrome, seizure and peripheral neuropathy. In all, 50 patients experienced 63 NCs-37 early (⩽day +100), 21 late (day +101 to 2 years) and 5 very late (2 to 5 years). The 1- and 5-year cumulative incidences of all NCs were 15.6% and 19.2%, respectively, and of CNS complication (CNSC; all of the above complications except peripheral neuropathy) were 12.2 and 14.5%. Risk factors for CNSC were age (hazard ratio (HR)=1.06 per year, P=0.0034), development of acute GvHD grade III-IV (HR=2.78, P=0.041), transfusion-dependent thrombocytopenia (HR=3.07, P=0.025) and delayed platelet engraftment (>90th centile; HR=2.77, P=0.043). CNSCs negatively impacted progression-free survival (HR=2.29, P=0.0001), overall survival (HR=2.63, P<0.0001) and non-relapse mortality (HR=8.51, P<0.0001). NCs after HCT are associated with poor outcomes, and usually occur early after HCT.

Risk Factors and Impact of Neurological Complications after Allogeneic Hematopoietic Stem Cell Transplantation

Introduction:A significant source of morbidity and mortality related to allogeneic hematopoietic cell transplantation (HCT) is neurologic complication. We performed a retrospective chart review to determine the incidence, risk factors, timing, and impact of neurologic complications in the first five years after HCT.Methods:We performed a retrospective chart review of patients undergoing allogeneic HCT for hematological disorders at the Massachusetts General Hospital between January 2000 and December 2010, focusing on neurologic complications after HCT. We determined the incidence of central nervous system (CNS) infections, intracranial hemorrhage, thromboembolic events, metabolic encephalopathy, posterior reversal encephalopathy syndrome (PRES), seizures, CNS malignancy, and peripheral neuropathy. We classified neurological events as either early (day -7 to day +100), late (day +101 to 2 years) or very late (2 years to 5 years). Risk factors studied were demographics (age, gender, race), disease-related factors (diagnosis, disease status, prior autologous transplant),transplant factors (myeloablative or reduced-intensity conditioning, use of antithymocyte globulin (ATG), stem cell source and GVHD prophylaxis). Outcome variables were neutrophil and platelet engraftment, progression free survival (PFS) and overall survival (OS).Results:There were 263 consecutive patients (median age 54 years, range 18 to 76 years). The diseases were acute myeloid leukemia n=91 (34.6%), non-Hodgkin lymphoma n=64 (24.3%), myelodysplastic syndrome n=41 (15.6%), acute lymphoblastic leukemia n=21 (8.0%), myeloproliferative neoplasm n=13 (4.9%), chronic lymphocytic leukemia n=12 (4.6%), Hodgkin lymphoma n=11 (4.2%), multiple myeloma n=10 (3.8%). Conditioning was myeloablative n=86 (33%), or reduced-intensity n= 177 patients (67%). Donor source was matched related donor n=153 (58.1%), matched unrelated donor n=52 (19.8%), haploidentical n=35 (13.3%), umbilical cord blood n=20 (7.6%), and mismatched unrelated donor n=3 (1.1%). The median days to ANC > 500x106/L, and platelet count > 20,000 x106/L unsupported were 15 (range 7 to 37 days) and 19 (range 7 to 167 days), respectively. The incidence of acute GVHD grades II-IV was 22% and the 1-year incidence of extensive chronic GVHD was 8.9%. The 5-year overall and progression free survivals were 37% and 29% respectively. The major cause of death was relapsed or progressive malignancy.15 patients (5.7%) experienced 19 clinically active neurologic events without having relapsed or progressed at the time, as follows: CNS infection n=0,CNS hemorrhage n=2, CNS thromboembolic event n=1, metabolic encephalopathy n=4, PRES n=3, seizure n=4, CNS malignancy n=4, and peripheral neuropathy n=5 (Table 1). 4 patients experienced CNS relapse as their first neurologic event post transplant. Patients who relapsed or progressed had a higher incidence of neurologic complications -55 of those patients (38.4% of patients who relapsed) experienced 79 neurologic events: CNS infection n=16,CNS hemorrhage n=14, CNS thromboembolic event n=14, metabolic encephalopathy n=14, PRES n=3, seizure n=9, CNS disease n=7, and peripheral neuropathy n=12(Table 2). After 100 days post transplant, neurologic complications were rare in patients who had not relapsed or progressed (2.2% of patients). In a multivariate analysis, risk factors for neurologic complication were relapsed/progressive disease, grade II-IV acute GVHD and use of sirolimus in GVHD prophylaxis. 4 of 17 patients who received sirolimus had a neurologic event (1 thromboembolic stroke, 1 seizure/PRES, 1 seizure/PRES/metabolic encephalopathy and 1 peripheral neuropathy). Neutrophil and platelet engraftment were not affected by neurologic complications. Neurologic complications negatively impacted OS (Hazard Ratio (HR) 3.5, p<0.001) and PFS (HR 2.2, p<0.0001).In summary, (1) Neurologic complications are uncommon after allogeneic HCT (5.7%); (2) Neurologic complications are more common in patients with relapsed or progressive disease (38.4%); (3) Neurologic complications are more common in patients receiving sirolimus-containing GVHD prophylaxis (23.5%), although limited by small numbers; (4) Neurologic complications are uncommon after 100 days (2.2%); (5) Neurologic complications were associated with decreased PFS and OS. [Display omitted] [Display omitted] DisclosuresChen:Novartis: Research Funding; Incyte Corporation: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding.

Perioperative Consultation for Patients with Preexisting Neurologic Disorders.

As the population ages, the prevalence of many neurologic diseases is increasing. At the same time, older patients are undergoing more surgical procedures. This confluence of events puts neurohospitalists in a unique position to provide both pre- and postoperative guidance to minimize complications, improve clinical outcomes, and decrease health care costs in patients with neurologic comorbidities. Early preoperative consultation is recommended for patients with severe, poorly controlled, or decompensated neurologic disease, a recent stroke, or those undergoing procedures with a high risk of neurologic complications. The neurohospitalist's role includes optimizing management of preexisting diseases, such as epilepsy, neuromuscular disorders, Parkinson's disease, dementia, and cerebrovascular disease, as well as providing guidance for perioperative management and clarification of risks. In the postoperative period, the neurohospitalist will frequently be consulted to mitigate any negative impact of neurologic complications that do occur.

Impact of Neurological Complications on the Overall Survival in Allogeneic Stem Cell Transplantation

▪ INTRODUCTIONNeurological complications (NC) are frequently reported after allogeneic hematopoietic stem cell transplantation (allo-HSCT), but their incidence, characteristics and impact on the overall survival are not well defined. For this reason, we retrospectively analyzed our experience. PATIENTS AND METHODSA retrospective study of 506 allo-HSCTs performed in our center from January 2000 to September 2013, including 336 myeloablative and 170 non-myeloablative, 280 sibling and 226 unrelated, and 397 matched and 109 mismatched. All neurological complications, according to NCCN classification, were included. RESULTSSeventy seven patients developed neurological complications. Their median age was 48 years (5-70) and 43 (56%) were male. Underlying diseases were Acute Leukemia (34), Myelodysplastic Syndrome (11), Multiple Myeloma (9), Non-Hodgkin Lymphoma (7), Myeloproliferative disease (7), Bone marrow Aplasia (5), Hodgkin Lymphoma (2) and other (2). Thirty eight patients (49.4%) were in CR, 14 (18.2%) in PR, 16 (20.8%) had a refractory disease and 9 (11.7%) had a stable disease. Median preceding treatments were 2 (0-10), including in 24 (31.2%) a preceding HSCT (19 autologous and 5 allogeneic). Fifty seven patients (74%) had received a myeloablative (MA) regimen (14 TBI and 43 chemotherapy). Stem cell source was bone marrow, peripheral blood and umbilical cord blood in 53, 20 and 4 patients, respectively. The donor was unrelated in 47 patients (61%) and mismatched in 25 (32.5%). A calcineurin inhibitor (Cyclosporine or Tacrolimus) was included in all cases as GVHD prophylaxis, combined with Methotrexate (37), Mycophenolate (35) and Prednisone (5).Seventy seven patients developed 81 NC (74 central and 7 peripheral). The global incidence was 16%, being more frequently reported in unrelated (21.4% vs. 11.4%, p=0.002) or mismatched (24.5% vs. 13.5%, p=0.007) allo-HSCT. Within the group who developed central NC, 48 patients (65%) had an early onset (less than 100 days after HSCT), which consisted of impairment of consciousness (36 patients), focal syndrome (22 patients) or seizures (16 patients). The etiology was toxic-metabolic in 32 patients (posterior encephalopathy in 10 cases), infectious in 21 (viral 10, fungal 6, bacterial 5), vascular in 12 (Thrombotic Thrombocytopenic Purpura 6, hemorrhagic 4, ischemic 2) and relapse in 9. Within the group who developed peripheral NC, 5 patients (71.5%) had a late onset, which consisted of polyneuropathy. The etiology was infectious in 2 cases (viral) and immune in 5 cases.Twenty four patients are alive (31.2%) with a median follow-up of 10 months (0-110). Excluding relapses, NC was a direct or indirect cause of death in 24 patients (54.5%), due to viral (9) and fungal (8) infections, above all. The development of a NC, specially in the central nervous system, had a negative impact on the overall survival (17 months vs. 40 months; p=0.001) (figure 1) CONCLUSIONSIn our series, the incidence of NC in the setting of allo-HSCT was 16%, being more frequently found with unrelated and mismatched donor. They were associated with high mortality, having a negative impact on the overall survival and becoming a direct or indirect cause of death in more than half of cases. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.