Independent Predictor Of Clinical Outcome Research Articles

HSR22-163: Real World Data and Independent Predictors of Clinical Outcomes with CDK Inhibitors in Metastatic ER+ Breast Cancer Patients

"HSR22-163: Real World Data and Independent Predictors of Clinical Outcomes with CDK Inhibitors in Metastatic ER+ Breast Cancer Patients" published on 31 Mar 2022 by National Comprehensive Cancer Network.

A nomogram based on tumor response to induction chemotherapy may predict survival in locoregionally advanced nasopharyngeal carcinoma.

To evaluate the clinical significance of tumor response to induction chemotherapy (IC) in locoregionally advanced nasopharyngeal carcinoma (LANPC) patients and further to develop a nomogram for predicting survival prognosis. A total of 498 patients with stage III-IVA NPC applying IC and concurrent chemotherapy were reviewed (training cohort, n=376; validation cohort, n=122). Tumor response was an independent predictor for clinical outcomes. The nomogram included age, N stage, pretreatment Epstein-Barr virus DNA, lymphocyte-to-monocyte ratio, and tumor response achieved an ideal C-index of 0.703 (95% CI 0.655-0.751) in the validation cohort for predicting overall survival (OS), which outperformed than that of the TNM system alone (C-index, 0.670, 95% CI: 0.622-0.718). In addition, the nomogram could successfully classified patients into different risk groups. We established and validated a precise and convenient nomogram based on tumor response for predicting the OS of LANPC patients.

Mid-wall striae fibrosis predicts heart failure admission, composite heart failure events, and life-threatening arrhythmias in dilated cardiomyopathy

Heart failure (HF) admission is a dominant contributor to morbidity and healthcare costs in dilated cardiomyopathy (DCM). Mid-wall striae (MWS) fibrosis by late gadolinium enhancement (LGE) imaging has been associated with elevated arrhythmia risk. However, its capacity to predict HF-specific outcomes is poorly defined. We investigated its role to predict HF admission and relevant secondary outcomes in a large cohort of DCM patients. 719 patients referred for LGE MRI assessment of DCM were enrolled and followed for clinical events. Standardized image analyses and interpretations were conducted inclusive of coding the presence and patterns of fibrosis observed by LGE imaging. The primary clinical outcome was hospital admission for decompensated HF. Secondary heart failure and arrhythmic composite endpoints were also studied. Median age was 57 (IQR 47–65) years and median LVEF 40% (IQR 29–47%). Any fibrosis was observed in 228 patients (32%) with MWS fibrosis pattern present in 178 (25%). At a median follow up of 1044 days, 104 (15%) patients experienced the primary outcome, and 127 (18%) the secondary outcome. MWS was associated with a 2.14-fold risk of the primary outcome, 2.15-fold risk of the secondary HF outcome, and 2.23-fold risk of the secondary arrhythmic outcome. Multivariable analysis adjusting for all relevant covariates, inclusive of LVEF, showed patients with MWS fibrosis to experience a 1.65-fold increased risk (95% CI 1.11–2.47) of HF admission and 1-year event rate of 12% versus 7% without this phenotypic marker. Similar findings were observed for the secondary outcomes. Patients with LVEF > 35% plus MWS fibrosis experienced similar event rates to those with LVEF ≤ 35%. MWS fibrosis is a powerful and independent predictor of clinical outcomes in patients with DCM, identifying patients with LVEF > 35% who experience similar event rates to those with LVEF below this conventionally employed high-risk phenotype threshold.

Abstract WP160: First-Pass Effect Modification In Proximal Vs Distal M1 Occlusion Thrombectomy

Modified first pass effect (mFPE) of TICI 2B or greater is an independent predictor of clinical outcome in patients who undergo mechanical thrombectomy (MT). Location of the occlusion in the M1 segment may affect the mFPE and may influence clinical outcomes. A comparison of mFPE between occlusions of the proximal and distal (sparing lenticulostriate branches) M1 segments of the MCA has yet to be performed. We aim to examine the interaction between first pass effect and clinical outcomes in proximal versus distal M1 occlusions. We performed retrospective analysis of patients who underwent MT between 2014 and 2020. Patients were included if they were treated for M1 occlusion within 24 hours from last seen normal, and achieved successful recanalization (TICI2b or greater). Patients were excluded if they were not successfully recanalized, or if they had other intracranial or multifocal occlusions. A total of 264 patients were included in this analysis. Ninety two patients had proximal M1 occlusions and 172 had distal M1 occlusions. Patients with proximal M1 occlusions had higher NIHSS (median 18 vs. 16, p=0.003), lower ASPECTS (mean 8.5 vs 9, p=0.02), and were less likely to be females (44.6% vs. 62.8%, p=0.006). Modified first pass effect was achieved in 45.3% of distal M1 occlusions compared to 31.9% of proximal (p=0.047). Excellent clinical outcome, defined as mRS of 0-1 at 90 days was higher in distal occlusion group (38.8% vs. 24.7%, p=0.03). Additionally, the proximal occlusion group was more likely to experience any grade of hemorrhagic transformation (HT) (37.4 vs. 23.3, p=0.02). Other baseline characteristics and time metrics did not differ between the two groups. In a multivariate analysis of predictors of excellent outcome in the overall cohort, ASPECTS (OR=1.39, p = 0.026) and proximal occlusion site (OR=0.485, p=0.037) were the only two independent predictors. Therefore, mFPE was not a predictor of excellent outcome when adjusted for exact location of occlusion.

Abstract TP153: First Pass Effect In Middle Cerebral Artery M1 Occlusions

Introduction: First pass effect (FPE) defined as TICI 3 recanalization or greater is an independent predictor of clinical outcome in patients who undergo mechanical thrombectomy (MT). The first pass effect may be impacted by device-related factors, thrombus composition, or collateral circulation flow dynamics. In this study, we aim to examine the impact of first pass effect on clinical outcomes in patients with MCA M1 occlusions. Methods: A retrospective analysis of all patients with MCA M1 occlusion who underwent successful mechanical thrombectomy (TICI 2b or greater) between 2014-2020 at two thrombectomy stroke centers was performed. Location of occlusion was recorded as proximal MCA (involvement of the lenticulostriate vessels) or distal. Patients were excluded if they were not successfully recanalized or if they had multifocal intracranial occlusions. Patient characteristics, time metrics, procedural data, and 90 day clinical outcomes were collected. The primary outcome of interest was first pass effect, defined as TICI 3 after a single pass. Results: A total of 261 patients achieved successful recanalization of MCA occlusions in our cohort, with 70 (26.8%) patients achieving a first pass effect. Baseline demographics, rates of IV-tPA administration, and time metrics were similar between the FPE and non-FPE group. Proportion of proximal MCA and distal MCA occlusions were similar between groups as well (38.2% vs. 25.7%; p=0.08). Rates of excellent clinical outcomes were significantly higher in the FPE group compared to the non-FPE group (46.3% vs. 29.9%; p=0.02). In a multivariate analysis, proximal MCA occlusion was a significant predictor of first pass effect. Conclusion: First pass effect in middle cerebral artery M1 occlusions is a significant predictor of an excellent clinical outcome. Patients with a proximal MCA M1 occlusion are more likely to achieve a first pass effect compared to patients with a distal MCA occlusion.

C4d as a Screening Tool and an Independent Predictor of Clinical Outcomes in Lupus Nephritis and IgA Nephropathy.

BackgroundAs an indispensable marker of complement cascades activation, C4d was confirmed of its crucial role in the pathogenesis of both lupus nephritis (LN) and IgA nephropathy (IgAN). While the studies directly comparing the diagnostic value, and outcomes predicting function of C4d between LN and IgAN are still absent.MethodsA cohort of 120 LN patients, 120 IgAN patients who were diagnosed by renal biopsy between January 2015 and December 2017 and 24 healthy age matched controls were prospectively analyzed. The patients were followed till December 2020. The outcomes were adverse disease treatment response (disease relapse) and kidney disease progression event (decline of estimated glomerular filtration rate by more than 20% or end-stage kidney disease). The renal C4d deposition proportion and pattern were compared between IgAN and LN patients. In addition, the relationship between renal C4d deposition and disease subtypes, disease relapse as well as disease progression for LN and IgAN patients were also analyzed.ResultsThe LN, IgAN patients and healthy controls were well matched in ages. The follow-up period was 38.5 (30.3–60.8) months for LN patients and 45.0 (30.5–57.0) months for IgAN patients. 78 patients (65.0%) with LN had renal C4d deposition, compared with only 39 IgAN patients (32.5%) with C4d deposition in renal tissues (P < 0.001). The LN patients shared different renal C4d distribution patterns with IgAN patients. Compared with IgAN patients, the C4d deposition in LN patients was significantly more in renal glomerulus (P < 0.001) and less in renal tubules (P = 0.003). For disease subtypes, renal C4d deposition was especially strong in class V membranous LN and IgAN with tubulointerstitial fibrosis (T1/T2) lesions. Renal C4d deposition was independently correlated with the disease relapse of LN patients (HR = 1.007, P = 0.040), and acted as an independent predictor of disease progression during the follow-up period for IgAN patients (HR = 1.821, P = 0.040).ConclusionsRenal C4d distribution proportion and pattern differed between LN and IgAN patients. The presence of C4d in renal tissue acted as an independent predictor of relapse for LN patients and disease progression for IgAN patients.

High Proliferating Regulatory T Cells Post-Transplantation Are Associated with Poor Survival in Lymphoma Patients Treated with Autologous Hematopoietic Stem Cell Transplantation

Autologous hematopoietic cell transplantation (AHCT) in lymphoma is well established and yields improved survival for patients with chemotherapy-sensitive disease. The patterns of immune cell reconstitution after AHCT have emerged as independent predictors of clinical outcomes. We sought to analyze the patterns of regulatory T cell (Treg) reconstitution after AHCT in non-Hodgkin lymphoma (NHL) and their correlations with clinical outcomes. In our prospective cohort study, we analyzed patterns of lymphocyte reconstitution and focused on T reg subsets for 41 patients who underwent AHCT for NHL between 2010 and 2016. Flow cytometry analysis was performed on blood samples collected prospectively at days +28, +60, and +100 post-AHCT. Patients' overall survival (OS) and progression-free survival (PFS) were correlated with Treg immune cell reconstitution. At day +28, Tregs comprised a median of 2.7% (range, 0.4% to 16.8%) of the total lymphocyte population. The proportion of proliferating Tregs (Ki67+ Tregs) varied widely from 6.3% to 59.2% (median, 16.1%) of total Tregs and has a significant effect on post-transplantation outcomes. AHCT recipients with low levels of proliferating Tregs (ie, <16.1%, Ki67+ Tregs) at 28 days had better 5-year OS compared to patients with high Ki67+ Treg levels (75% versus 42%; P=.01). Higher levels of proliferating Tregs at day +28 post-AHCT were associated with higher mortality, with the most frequent cause of death due to lymphoma progression. This association suggests that immunosuppressive cellular reconstitution adversely impacts survival in AHCT recipients with NHL.

ASO Visual Abstract: Comprehensive Analysis of Somatic Mutations in Driver Genes of Resected Pancreatic Ductal Adenocarcinoma Shows KRAS G12D and Mutant TP53 Combination as an Independent Predictor of Clinical Outcome

ASO Visual Abstract: Comprehensive Analysis of Somatic Mutations in Driver Genes of Resected Pancreatic Ductal Adenocarcinoma Shows KRAS G12D and Mutant TP53 Combination as an Independent Predictor of Clinical Outcome

Differential Leucocytes Count: An Independent Predictor of Clinical Outcomes in SARS-CoV-2 Patients

SARS-CoV-2 is a systemic infection that has a significant impact on the hemostasis and hematopoietic system. Lymphopenia may be considered a cardinal laboratory finding, with prognostic potential. The study aimed to determine the differential leukocyte count in SARS-CoV-2 among Sudanese patients, during the period from March to December 2020. A total of 787 subjects were enrolled 487 patients with COVID-19 and 300 healthy volunteers as a control group; their ages ranged from 29 to 89 years. 3 ml

Incidence and Outcomes of Acute Heart Failure With Preserved Versus Reduced Ejection Fraction in SPRINT

In the SPRINT (Systolic Blood Pressure Intervention Trial), intensive BP treatment reduced acute decompensated heart failure (ADHF) events. Here, we report the effect on HF with preserved ejection fraction (HFpEF) and HF with reduced EF (HFrEF) and their subsequent outcomes. Incident ADHF was defined as hospitalization or emergency department visit, confirmed, and formally adjudicated by a blinded events committee using standardized protocols. HFpEF was defined as EF ≥45%, and HFrEF was EF <45%. Among the 133 participants with incident ADHF who had EF assessment, 69 (52%) had HFpEF and 64 (48%) had HFrEF (P value: 0.73). During average 3.3 years follow-up in those who developed incident ADHF, rates of subsequent all-cause and HF hospital readmission and mortality were high, but there were no significant differences between those who developed HFpEF versus HFrEF. Randomization to the intensive arm had no effect on subsequent mortality or readmissions after the initial ADHF event, irrespective of EF subtype. During follow-up among participants who developed HFpEF, although relatively modest number of events limited statistical power, age was an independent predictor of all-cause mortality, and Black race independently predicted all-cause and HF hospital readmission. In SPRINT, intensive BP reduction decreased both acute decompensated HFpEF and HFrEF events. After initial incident ADHF, rates of subsequent hospital admission and mortality were high and were similar for those who developed HFpEF or HFrEF. Randomization to the intensive arm did not alter the risks for subsequent all-cause, or HF events in either HFpEF or HFrEF. Among those who developed HFpEF, age and Black race were independent predictors of clinical outcomes. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01206062.

Abstract 12919: Impact of Small Valve Size After Transcatheter Aortic Valve Implantation on 1-year Outcomes in Women: Results From the WIN-TAVI Registry

Introduction: Women undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis are more likely to have a small aortic annulus compared with men. However, there is lack of data on the prognostic relevance of bioprostheses size in women. Hypothesis: To assess the impact of a small valve size on clinical outcomes in women undergoing TAVI. Methods: The Women's INternational Transcatheter Aortic Valve Implantation (WIN-TAVI) registry was the first study to investigate the safety and efficacy of TAVI in women with aortic stenosis.Patients were stratified according to the size of aortic valve bioprosthesis, with small valve defined by a size≤23 mm and non-small valve defined by a size&gt;23 mm. The primary outcome of interests was the occurrence of Valve Academic Research Consortium (VARC)-2-efficacy endpoint, a composite of all-cause death, stroke, myocardial infarction, hospitalization for valve-related symptoms or heart failure or valve-related dysfunction at 1-year follow-up. Results: Out of 934 patients, 388 (41.5%) received a small valve and had a lower body mass index, lower surgical risk scores and were less likely to suffer from atrial fibrillation as compared with patients receiving a larger valve. The latter were more likely to require post-dilation (18.6% vs. 10.4%, p&lt;0.001) and had a trend for higher rates of residual aortic regurgitation grade ≥2 (8.7% vs. 5.1%, p = 0.051). At 1 year, the risk of the VARC-2 efficacy endpoint was similar between the two groups (16.0% in small valve vs. 16.3% in non-small valve, p = 0.8808; adjusted hazard ratio 1.34, 95% confidence interval 0.90 to 2.00), Figure. No significant differences in the occurrence of the secondary endpoints were noted after multivariable adjustment. Conclusions: Among women undergoing TAVI, the valve size was associated with different baseline and procedural characteristics but was not an independent predictor of clinical outcomes.

Influence of Estimated Glomerular Filtration Rate on Clinical Outcomes in Patients with Acute Ischemic Stroke Not Receiving Reperfusion Therapies.

Background: We aimed to determine whether estimated glomerular filtration rate (eGFR) is an independent predictor of clinical outcomes in patients with acute ischemic stroke not treated with reperfusion therapy. Methods: A total of 1420 patients with acute ischemic stroke from a hospital-based stroke registry were included in this study. Patients managed with intravenous thrombolysis or endovascular reperfusion therapy were excluded. The included patients were categorized into five groups according to eGFR, as follows: ≥90, 60–89, 45–59, 30–44, and <30 mL/min/1.73 m2. The effects of eGFR on functional outcome at discharge, in-hospital mortality, neurologic deterioration, and hemorrhagic transformation were evaluated using logistic regression analyses. Results: In univariable logistic regression analysis, reduced eGFR was associated with poor functional outcome at discharge (p < 0.001) and in-hospital mortality (p = 0.001), but not with neurologic deterioration and hemorrhagic transformation. However, no significant associations were observed between eGFR and any clinical outcomes in multivariable analysis after adjusting for clinical and laboratory variables. Conclusions: Reduced eGFR was associated with poor functional outcomes at discharge and in-hospital mortality but was not an independent predictor of short-term clinical outcomes in patients with acute ischemic stroke who did not undergo reperfusion therapy.

Estimated glomerular filtration rate may be an independent predictor for clinical outcomes regardless of acute kidney injury complication in the emergency department.

Study objectiveAcute kidney injury (AKI), chronic kidney disease (CKD), and decreased estimated glomerular filtration rate (eGFR) are all associated with poor clinical outcomes among emergency department (ED) patients. This study aimed to evaluate the effect of different types of renal dysfunction and the degree of eGFR reduction on the clinical outcomes in a real-world ED setting.MethodsAdult patients with an eGFR lower than 60 mL/min/1.73m2 in our ED, from October 1, 2016, to December 31, 2016, were enrolled in this retrospective observational study. Besides AKI and CKD, patients with unknown baseline renal function before an ED visit were categorized in the undetermined renal dysfunction (URD) category.ResultsAmong 1495 patients who had eGFR evaluation at ED, this study finally enrolled 441 patients; 22 patients (5.0%) had AKI only, 32 (7.3%) had AKI on CKD, 196 (44.4%) had CKD only, 27 (6.1%) had subclinical kidney injury (those who met neither criteria for AKI nor CKD), and 164 (37.2%) had URD. There was a significant association between eGFR and critical illness defined as the composite outcome of death or intensive care unit (ICU) need, hospitalization, ICU need, death, and renal replacement therapy need (odds ratio [95% confidence interval]: 1.72 [1.45–2.05], 1.36 [1.16–1.59], 1.66 [1.39–2.00], 1.73 [1.32–2.28], and 2.71 [1.73–4.24] for every 10 mL/min/1.73m2 of reduction, respectively). Multivariate logistic regression analysis showed eGFR was an independent predictor of critical illness composite outcome (death or ICU need), hospitalization, and ICU need even after adjustment with AKI or URD.ConclusionsEstimated GFR may be a sufficient predictor of clinical outcomes of ED patients regardless of AKI complication. Considerable ED patients were determined as URD, which might have a significant impact on the ED statistics regarding renal dysfunction.

CatLet score and Clinical CatLet score as predictors of long-term outcomes for patients with acute myocardial infarction undergoing delayed percutaneous coronary intervention

Abstract Background We have recently developed a Coronary Artery Tree description and Lesion EvaluaTion (CatLet) angiographic scoring system based on the 17 myocardial segment model, law of competitive blood supply, and law of flow conservation. This novel angiographic scoring system can be utilized to account for the variable coronary anatomy, the severity and complexity of coronary artery lesions, and to standardize the collection of angiographic data. Our preliminary study demonstrated that the CatLet score better predicted clinical outcomes than the SYNTAX score for patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI). The current study aimed at assessing whether the CatLet score (CS) and the Clinical CatLet score (CCS) predicted clinical outcomes for AMI patients undergoing delayed PCI. Methods The CS was calculated in 1018 consecutively prospectively enrolled AMI patients. Primary end point was major adverse cardiac events (MACEs), a composite of myocardial infarction, cardiac death, and ischemia-driven revascularization. CCS was calculated multiplying the CS by the ACEF score constructed using age, creatinine, and LVEF. Tertile partitioning of CS and CCS were as follows: CSlow ≤12, CSmid 13–18, and CStop ≥19; CCSlow ≤13, CCSmid 14–24, and CCStop ≥25, respectively. Cox regression analysis was employed to identify the associations between predictors and clinical outcomes. Results Four-year MACE rates were significantly higher with CStop compared with CSlow [4.82 (3.39–6.85), P&amp;lt;0.001], which was also the case for all-cause death, cardiac death, myocardial infarction, and ischemia-driven revascularization; for all these endpoints, there were a significant trend (P&amp;lt;0.001) for higher event rates with the increasing CS tertiles as shown in Figure 1. Stratifying outcomes across CCS tertiles resulted in similar results for the comparisons between CCStop and CCSlow. For MACEs, CCS had a significantly increased C-index [(C-index (95% CI), 0.725 (0.692–0.759) vs. 0.693 (0.659–0.727), P=0.001] compared with CS, which was also the case for all-cause death, cardiac death, and myocardial infarction. However, for ischemia-driven revascularization, CCS had a slightly decreased C-index [0.655 (0.609–0.701) vs. 0.670 (0.625–0.716), P=0.235] compared with CS, without a significant difference. In terms of calibration, CCS was comparable to CS for MACEs, all-cause death, cardiac death, and myocardial infarction. However, calibration for ischemia-driven revascularization worsened for CCS compared with CS (χ2=22.07, P=0.004 vs. χ2=7.79, P=0.454). Both scores remained to be independent predictors of clinical outcomes (in separate models) after adjustment for a broad spectrum of risk factors. Conclusions CS and to a greater extent CCS were able to risk-stratify long-term outcomes in AMI patients undergoing delayed PCI. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): 2020YFC2004705 &amp; SYS2019040 Figure 1. Kaplan-Meier curves for endpoints

Immunohistochemical Analysis of CYP11B2, CYP11B1 and β-catenin Helps Subtyping and Relates With Clinical Characteristics of Unilateral Primary Aldosteronism.

Background: Primary aldosteronism is caused by aldosterone overproduction. While conventional hematoxylin-eosin staining can demonstrate morphological abnormality, it cannot provide any functional histopathological information. We aimed to identify the diagnostic, functional and prognostic value of CYP11B2, CYP11B1, and β-catenin immunostaining in unilateral hyperaldosteronism. Method: A total of 134 patients with unilateral hyperaldosteronism were recruited in our study. The expression of CYP11B2, CYP11B1, and β-catenin was evaluated semiquantitatively on 134 patients’ sections using immunohistochemistry technology and the relationship with clinical data was assessed. Results: Patients were classified into four subtypes based on CYP11B2 staining as below: (1)118 patients with unilateral single aldosterone-producing adenoma (APA), (2)11 with unilateral multiple APA, (3)four with aldosterone-producing cell cluster (APCC), and (4)one with an undefined source. Adjusted CYP11B2 H-score was correlated with serum aldosterone, aldosterone to renin ratio (ARR), and serum potassium. In the abnormal β-catenin staining group, hypertension duration, aldosterone, ARR, cortisol, tumor diameter, tumor area, and CYP11B2 H-score were significantly higher than those of the wild-type group. Serum potassium level was significantly lower in the abnormal β-catenin staining group. Age, gender, BMI, family history of hypertension, adjusted CYP11B2 and CYP11B1 H-scores differed significantly between complete clinical success and incomplete clinical success groups. Age, gender and family history of hypertension were independently associated with complete clinical success based on multivariate logistic regression analysis. Conclusion: CYP11B2 immunostaining could improve the differential diagnosis of unilateral hyperaldosteronism. Adjusted CYP11B2 H-score could be used as a histopathological marker to reflect the severity of unilateral APA. Dysregulation of Wnt/β-catenin signaling and impaired β-catenin degradation may provoke the proliferation and enhance the steroidogenic ability of APA tumor cells, indicating that the Wnt pathway might be a potential, actionable, therapeutic target in the treatment of hyperaldosteronism. Age, sex and family history of hypertension were independent predictors of clinical outcome after adrenalectomy for unilateral hyperaldosteronism.

Blood flow rate: An independent risk factor of mortality in Chinese hemodialysis patients.

Studies suggested the association between blood flow rate (BFR) and mortality might be beyond dialysis adequacy. This study aimed to explore if BFR is an independent predictor of clinical outcomes in Chinese hemodialysis (HD) patients. This study included data from patients in China Dialysis Outcomes and Practice Patterns Study (DOPPS) Phase 5. Patients with a record of BFR were included, and demographic data, comorbidities, hospitalization, and death records were collected. Associations between BFR and all-cause mortality and hospitalization were analyzed using Cox regression models. One thousand four hundred twelve (98.9%) patients were included. Most patients were with BFR < 300 ml/min. After full adjustment, each 10-ml/min increase of BFR was associated with a 6.4% decrease in all-cause mortality risk (HR: 0.936, 95% CI: 0.880-0.996) but not first hospitalization (HR: 0.987, 95% CI: 0.949-1.027). The impact of BFR on mortality may be more prominent in patients who were male gender, nondiabetic, albumin < 4.0 g/dl, and hemoglobin ≥ 9.0 g/dl. Increased BFR is independently associated with a lower risk of all-cause mortality within the range of BFR 200-300 ml/min. And this effect is more pronounced in patients who were male gender, nondiabetic, albumin < 4.0 g/dl, and hemoglobin ≥ 9.0 g/dl.

630 IMPACT OF LOW SKELETAL MUSCLE MASS AND DENSITY ON OUTCOMES OF LOCALLY ADVANCED ESOPHAGEAL CANCER PATIENTS TREATED WITH RADICAL RADIOTHERAPY

Abstract Low skeletal muscle mass and density are independent predictors of clinical outcomes in multiple gastrointestinal cancers. However, its effect on the long-term survival of locally advanced esophageal cancer patients undergoing radical radiotherapy is still unclear. Methods Patients with stage II-III esophageal cancer undergoing radical radiotherapy, enrolled in a observational cohort study, were included. Skeletal muscle mass and density were measured on CT. Patients with high and low skeletal muscle mass and density were compared regarding overall survival (OS). Results 165 patients (75.8% males, median age 63) were included, from March-2012 to September-2017. Before radiotherapy, 26.7% patients had low skeletal-muscle-mass and 23.0% patients had low skeletal-muscle-density. After radiotherapy, 40.6% patients had low skeletal-muscle-mass and 30.3% patients had low skeletal-muscle-density.The median OS of high skeletal-muscle-mass/density group was significantly higher than that of low skeletal-muscle-mass/density group before radiotherapy (28.7 vs 28.2 months, p = 0.041; 29.6 vs 16.9 months, p = 0.025). The median OS of high skeletal-muscle-mass/density group was also significantly higher than that of low skeletal-muscle-mass/density group after radiotherapy (30.3 vs 20.3 months, P = 0.012; 29.6 vs 17.2 months, p = 0.018). Conclusion Low skeletal muscle mass and density are associated with long-term outcome in patients undergoing radical radiotherapy. It is suggested that oncologists should pay more attention to the management of muscle mass and density of patients with esophageal cancer undergoing radiotherapy in order to improve their nutritional status and long-term survival.

Serum Soluble Tumor Necrosis Factor Receptors 1 and 2 Are Early Prognosis Markers After ST-Segment Elevation Myocardial Infarction.

Background: As inflammation following ST-segment elevation myocardial infarction (STEMI) is both beneficial and deleterious, there is a need to find new biomarkers of STEMI severity.Objective: We hypothesized that the circulating concentration of the soluble tumor necrosis factor α receptors 1 and 2 (sTNFR1 and sTNFR2) might predict clinical outcomes in STEMI patients.Methods: We enrolled into a prospective cohort 251 consecutive STEMI patients referred to our hospital for percutaneous coronary intervention revascularization. Blood samples were collected at five time points: admission and 4, 24, 48 h, and 1 month after admission to assess sTNFR1 and sTNFR2 serum concentrations. Patients underwent cardiac magnetic resonance imaging at 1 month.Results: sTNFR1 concentration increased at 24 h with a median of 580.5 pg/ml [95% confidence interval (CI): 534.4–645.6]. sTNFR2 increased at 48 h with a median of 2,244.0 pg/ml [95% CI: 2090.0–2,399.0]. Both sTNFR1 and sTNFR2 peak levels were correlated with infarct size and left ventricular end-diastolic volume and inversely correlated with left ventricular ejection fraction. Patients with sTNFR1 or sTNFR2 concentration above the median value were more likely to experience an adverse clinical event within 24 months after STEMI [hazards ratio (HR): 8.8, 95% CI: 4.2–18.6, p < 0.0001 for sTNFR1; HR: 6.1, 95% CI: 2.5 –10.5, p = 0.0003 for sTNFR2]. Soluble TNFR1 was an independent predictor of major adverse cardiovascular events and was more powerful than troponin I (p = 0.04 as compared to the troponin AUC).Conclusion: The circulating sTNFR1 and sTNFR2 are inflammatory markers of morphological and functional injury after STEMI. sTNFR1 appears as an early independent predictor of clinical outcomes in STEMI patients.

250. The association between patient activation and patient reported outcomes (PROs) for patients undergoing elective spine surgery

<h3>BACKGROUND CONTEXT</h3> Patient activation refers to the extent with which patients play an active, engaged role in their own health care. An increasing number of studies in spine and broader orthopedic literature have found patient activation to be both modifiable and an independent predictor of clinical outcomes, including satisfaction. No prior studies, however, have explored the impact of patient activation on whether patients achieve minimal clinical improvement difference (MCID) for PROMIS pain and physical function at 1-year follow-up. <h3>PURPOSE</h3> To determine whether patient activation, a modifiable risk factor, predicts MCID for PROMIS pain and physical function for patients undergoing elective cervical or thoracolumbar spine surgery. <h3>STUDY DESIGN/SETTING</h3> Retrospective review of single, academic institution database. <h3>PATIENT SAMPLE</h3> A total of 430 patients were identified who had undergone elective spine surgery and had minimum 1-year follow-up. <h3>OUTCOME MEASURES</h3> The primary outcome measure was whether patients achieved MCID for PROMIS pain and physical function at 1-year follow-up. <h3>METHODS</h3> We retrospectively reviewed a single-institution, academic database of patients undergoing elective cervical or thoracolumbar spine surgery. Inclusion criteria was (1) age 18 or older, and (2) minimum 1-year follow-up. We assessed patient activation using the validated Patient Activation Measures-13 (PAM-13) survey. Using the PAM-13 survey, we can numerically quantify patient activation and stratify patients into one of four stages of activation (I, II, III, IV), with a higher stage indicating greater activation. Primary outcome variable was achieving MCID at 1-year follow-up for PROMIS pain and physical function. Multivariable logistic regression analysis was used to determine impact of patient activation on MCID for PROMIS pain and physical function while controlling for demographics (age, sex), income and education. <h3>RESULTS</h3> Of the 430 patients meeting inclusion criteria, 210 (49%) were female with a mean age of 58.2 ± 16.8. Preoperatively, 34 (8%) were in activation stage 1, 45 (10%) in stage 2, 98 (23%) in stage 3, and 253 (59%) in stage 4. At 1-year postoperative follow up, 248 (58%) achieved MCID for PROMIS function and 256 (60%) achieved MCID for PROMIS pain. Using multivariable logistic regression, patients at higher stages of activation were more likely to achieve MCID for both PROMIS pain and physical function, compared to patients at stage 1 activation. With regards to PROMIS physical function, when compared to patients at stage 1 activation, patients at stage 2 (aOR:3.40, 95% CI: 1.25, 9.30), stage 3 (aOR:3.39, 95% CI: 1.34, 8.56) and stage 4 (aOR:7.63, 95% CI: 3.19, 18.3) were far more likely to achieve MCID. With regards to PROMIS pain, when compared against patients at stage 1, patients at stage 3 (aOR:2.78, 95% CI: 1.17, 6.63) and stage 4 (aOR:5.49, 95% CI: 2.43, 12.4) were far more likely to achieve MCID. Of note, for PROMIS pain, no difference in achieving MCID were observed between patients at stage 1 and 2. <h3>CONCLUSIONS</h3> We found patient activation to be an independent predictor of MCID for both PROMIS pain and physical function for patients undergoing elective spine surgery. Given our findings, we recommend routine assessment of patient activation. And, for patients found to be at the lowest stage of activation, they should be counseled regarding the increased risk of poor outcomes, and interventions to increase activation should be considered. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

In Reply to the Letter to the Editor Regarding "The Combination of Neutrophil-to-Lymphocyte Ratio and Admission Glasgow Coma Scale Score Is an Independent Predictor of Clinical Outcome in Diffuse Axonal Injury"

In Reply to the Letter to the Editor Regarding "The Combination of Neutrophil-to-Lymphocyte Ratio and Admission Glasgow Coma Scale Score Is an Independent Predictor of Clinical Outcome in Diffuse Axonal Injury"