Independent Prognostic Factor For Death Research Articles

Predictive Value of Perioperative Cardiac Troponin I in Patients Undergone Liver Transplantation: A Retrospective Cohort Study.

To examine the change rule and clinical significance of cardiac troponin I (cTnI) in the perioperative period of liver transplantation in adults, as well as its association with 28-day mortality. This was a retrospective cohort study: patients who underwent elective orthotopic liver transplantation (OLT) in Beijing Chao-Yang Hospital between June 2015 and June 2020 were selected, and plasma cTnI values were collected through the electronic medical record system within 7 days after surgery. Furthermore, the baseline clinical data of these patients were collected, and the change curve of cTnI values following liver transplantation was plotted. Using univariate and multivariate logistic regression models, the relationship between the level of postoperative cTnI and short-term mortality was investigated. The primary study endpoint was mortality within 28 days after surgery. We included 414 patients who had undergone liver transplantation in this study, 48 of whom died within 28 days after surgery. cTnI, a specific marker of myocardial injury, could predict that the postoperative cardiovascular complications were higher in the death group and significantly affect the short-term prognosis of patients; however, its prognostic cut-off value was approximately 0.545 ng/mL (13×URL), indicating that a minor elevation of cTnI after liver transplantation did not significantly affect the prognosis. Moreover, a comparison of the baseline data and postoperative ICU management scores of the two groups revealed that diabetes, maximum value of cTnI >0.545 ng/mL within 7 days, and the need for postoperative renal replacement therapy (RRT) were independent prognostic factors of death within 28 days after liver transplantation. Within 7 days after surgery, an increase in cTnI to the maximum value of 0.545 ng/mL (13×URL) could have a significant impact on the short-term prognosis of patients. Diabetes and postoperative RRT were two independent prognostic factors for liver transplantation perioperative mortality.

#3479 RISK FACTORS OF DEATH OR CHRONIC RENAL REPLACEMENT THERAPY REQUIREMENTS IN PATIENTS WITH THROMBOTIC MICROANGIOPATHIES WITHOUT ADAMTS-13 DEFICIENCY

Abstract Background and Aims Thrombotic microangiopathy without severe ADAMTS-13 deficiency activity levels (TMA-13n) has a high mortality rate. Early recognition of patients at higher risk of dying or needing chronic renal replacement therapy (composite outcome: CO) has become of paramount importance since treatments such as eculizumab could ameliorate the prognosis of this group of patients. Plasmic score have been shown to predict severe ADAMTS-13 deficiency; however, its role as a prognostic factor of CO in TMA-13n is unknown. Method We retrospectively evaluate the potential factors associated with the risk of CO. Patients diagnosed with TMA-13n (defined by microangiopathic anaemia, thrombocytopenia, organ damage and ADAMTS-13 activity ≥ 10%) from January 2008 to May 2018 in our centre were included in the study. Results Forty-two consecutive patients were included. Mean (SD) age: 41(20) years. Twenty-five (60% were females. Mean (SD) ADAMTS-13 activity: 69 (24%). Twenty-six (62%) patients required dialysis at admission. Nineteen (45%) met CO (10 patients died). Higher age, lower lactate dehydrogenase, PLASMIC score values ≤ 4, neuroradiological damage and early eculizumab use [median (IQR): 4 (0-16) days from hospital admission: 5] were factors associated with the risk for developing CO. Only three factors were independently associated with CO mortality by logistic regression: early use of eculizumab (OR: 0.14; 95% CI: 0.02-0.94) and neuroradiological damage (OR: 6.67; 95% CI: 1.12-39.80) and PLASMIC score ≤ 4 (OR: 7.39; 95% CI: 1.18-46.11). Conclusion In TMA-13n patients, neuroradiological damage, low PLASMIC score and early use of eculizumab were independent prognostic factors of death and chronic renal replacement therapy requirements.

Staphylococcus aureus bloodstream infection in a Chinese tertiary-care hospital: A single-center retrospective study.

Staphylococcus aureus bloodstream infection in a Chinese tertiary-care hospital: A single-center retrospective study.

Impact of anti-SARS-CoV-2 monoclonal antibodies in the management of patients with lymphoma and COVID19: A retrospective study.

COVID19 in patients affected by lymphoma represents an important challenge because of the higher mortality rate. Anti-SARS-CoV-2 monoclonal antibodies (anti-S MoAbs) appear promising in this setting. We report a monocentric retrospective study including 176 patients affected by lymphoma which developed SARS-CoV-2 infection since the start of COVID19 pandemic. Overall, mortality was 13.1%, with a decreasing trend between first waves to the last wave of pandemic (18.5% vs. 9.4%, p 0.076). Patients receiving anti-S MoAbs (41.3%) showed inferior mortality rate (overall survival, OS 93.2% vs. 82.7%, p 0.025) with no serious toxicity, reduced documented pneumonia (26% vs. 33%, p 0.005), and reduced need of oxygen support (14.5% vs. 35.7%, p 0.003). Among patients who received 3 doses of vaccine, the employment of anti-COVID MoAbs showed a trend of superior survival versus those who did not receive Anti-S MoAbs (OS rates 97.3% vs. 84.2%, p 0.064). On multivariate analysis, activehaematological disease (OS 72% (HR 2.49 CI 1.00-6.41), bendamustine exposure (OS 60% HR 4.2 CI 1.69-10.45) and at least one comorbidity (HR 6.53 CI 1.88-22.60) were independent prognostic factors for death. Our study confirms the adverse prognostic role of COVID-19 in lymphoma patients in presence of active disease, comorbidities and previous exposure to bendamustine. In our experience, anti-S MoAbs represented a therapeutic option in vaccinated patients.

Prognostic significance of 24-h blood pressure and variability indices in the outcome of acute ischaemic stroke.

The association between blood pressure (BP) levels and BP variability (BPV) following acute ischaemic stroke (AIS) and outcome remains controversial. To investigate the predictive value of systolic BP (SBP) and diastolic BP (DBP) and BPV measured using 24-h ambulatory blood pressure monitoring (ABPM) methods during AIS regarding outcome. A total of 228 AIS patients (175 without prior disability) underwent ABPM every 20 min within 48 h from onset using an automated oscillometric device (TM 2430, A&D Company Ltd) during day time (7:00-22:59) and night time (23:00-6:59). Risk factors, stroke subtypes, clinical and laboratory findings were recorded. Mean BP parameters and several BPV indices were calculated. End-points were death and unfavourable functional outcome (disability/death) at 3months. A total of 61 (26.7%) patients eventually died. Multivariate logistic regression analysis revealed that only mean night-time DBP (hazard ratio (HR): 1.04; 95% confidence interval (CI): 1.00-1.07) was an independent prognostic factor of death. Of the 175 patients without prior disability, 79 (45.1%) finally met the end-point of unfavourable functional outcome. Mean 24-h SBP (HR: 1.03; 95% CI: 1.00-1.05), day-time SBP (HR: 1.02; 95% CI: 1.00-1.05) and night-time SBP (HR: 1.03; 95% CI: 1.01-1.05), SBP nocturnal decline (HR: 0.93; 95% CI: 0.88-0.99), mean 24-h DBP (HR: 1.08; 95% CI: 1.03-1.13), day-time DBP (HR: 1.07; 95% CI: 1.03-1.12) and night-time DBP (HR: 1.06; 95% CI: 1.02-1.10) were independent prognostic factors of an unfavourable functional outcome. In contrast with BPV indices, ABPM-derived BP levels and lower or absence of BP nocturnal decline in the acute phase are prognostic factors of outcome in AIS patients.

Chronic kidney disease is potentially an independent prognostic factor for death in Stevens-Johnson syndrome and toxic epidermal necrolysis patients.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are mucocutaneous conditions associated with high mortality and morbidity. Although several prognostic factors have been proposed, some may have yet to be identified. A 14-year retrospective cohort study of patients with SJS/TEN was conducted at a university-based hospital in Bangkok, Thailand, to explore additional prognostic factors for mortality of patients with SJS/TEN. Medical records of all patients aged ≥18 years who were diagnosed with SJS, SJS-TEN overlap, or TEN between 2007 and 2020 were reviewed. Univariate and multivariate analyses were performed to examine associations between death and potential prognostic factors. A total of 76 patients with a mean age of 52 years were enrolled. Among them, 46, 15, and 15 patients were diagnosed with SJS, SJS-TEN overlap, and TEN, respectively. Overall, 10 patients deceased, marking a mortality rate of 13.2%. Based on an algorithm for assessment of drug causality for epidermal necrolysis, drug was the major cause of disease (96.1%). Allopurinol and trimethoprim/sulfamethoxazole were the most frequent culprit drugs. Univariate analysis revealed nine prognostic factors related to death, i.e., age, malignancy, chronic kidney disease (CKD), coronary artery disease, heart rate >120 beats/min, diagnoses of SJS-TEN overlap and TEN, blood urea nitrogen (BUN) >10 mmol/L, hemoglobin <10 g/dL, and serum albumin <2 g/dL. Causality with regard to drug, drug notoriety, time interval from drug intake to onset of reaction, and timing of culprit drug withdrawal were not significantly associated with death. Four independent prognostic factors for mortality were identified from multivariate analysis, i.e., TEN (risk ratio [RR] 8.29, 95% confidence interval [CI]: 2.71–25.38), malignancy (RR 3.34, 95% CI: 1.68–6.69), BUN >10 mmol/L (RR 3.02, 95% CI: 1.28–7.14), and early-stage CKD (RR 4.81, 95% CI: 2.49–9.28). Our findings suggest that CKD is an independent prognostic factor for mortality of patients with SJS/TEN besides those from the SCORTEN.

Prognostic role of serial electrocardiographic changes in patients with acute pulmonary embolism. Data from the Italian Pulmonary Embolism Registry

BackgroundThe prognostic role of serial electrocardiographic modifications in patients with acute pulmonary embolism (PE) have been poorly investigated. We evaluate the electrocardiographic changes in PE patients during their hospitalization and the prognostic role of such ECG modifications in respect to 30-day mortality in patients enrolled in the Italian Pulmonary Embolism Registry (IPER). MethodsSubjects enrolled into the IPER (September 2006–August 2010) were stratified according to their hemodynamic status, as high- (hemodynamically unstable) and non-high-risk (hemodynamically stable) patients. ECG features were analysed at three fixed time points: at presentation, on day 3 and at discharge. ResultsOverall, 687 patients (286 males, mean age 69.0 ± 15.5 years) were included in the study. Among these, 71 (10.3 %) were at high-risk. In these patients, multivariate analysis revealed that the persistence of right ventricular strain (RVS) after three days from hospitalization was a predictor of 30-day mortality [HRa: 2.78 (95 % CI: 1.05–7.31, p = 0.003)]. Moreover, the persistence of right bundle branch block (RBBB) [HRa: 2. 48 (95 % CI: 1.03–5.09, p = 0.002)], negative T waves in V1-V4 (NTWs) [HRa: 1.63 (95 % CI: 1.04–2.55), p < 0.0001] and qR complex in lead V1 [HRa: HR: 5.44, (95 % CI: 3.22–9.44, p < 0.0001)] were associated with an increased risk of 30-day mortality. When RBBB, NTWs and qR complex in V1 lead were present concomitantly, the 30-day risk of death resulted significantly higher [HR: 12.5 (95 % CI: 3.39–46.4,) p < 0.0001]. ConclusionsPersistence of RBBB, NTWs, and qR pattern in V1 lead at day 3 of hospitalization are independent prognostic factors of death within 30 days in high-risk acute PE patients. The prognostic power of any single ECG abnormality is lower compared to the combination of the three ECG variables.

P285 PROGNOSTIC ROLE OF ELECTROCARDIOGRAPHIC TEMPORAL CHANGES IN PATIENTS WITH ACUTE PULMONARY EMBOLISM. DATA FROM THE ITALIAN PULMONARY EMBOLISM REGISTRY (IPER)

Abstract Background The potential prognostic role of ECG changes during the course of acute pulmonary embolism (PE) has been poorly investigated over the years. Methods Data of patients prospectively enrolled in the IPER registry, having three ECGs (the first perfromed on admission, the second after three days of hospitalization and the third at discharge) were extracted and analyzed. Results Overall, 687 patients (286 males, mean age 69.0 ± 15.5 years) were included in the study. The negativization of electrocardiographic signs of right ventricualr strain (RVS) (Right bundle branch block –RBBB), S1Q3T3 and negative T waves from V1 to V4) followed the same pattern in both non–high (i.e. hemodynamically stable) and high–risk (i.e. hemodynamically unstable) patients, showing firstly the normalization of the S1QT3 pattern followed by the resolution of the RBBB. Conversely, additional NTWs appeared between the first and second ECGs in about 20% of cases and then partially normalized at discharge. Persistence of RVS at the second ECG was associated with a higher risk of death within 30 days only in high–risk patients [HRa: 2.78 (95% CI: 1.05–7.31. P = 0.03), with a sensitivity, specificity, PPV and PPN of 90.0%, 94.1%, 85.7% and 96.0%, respectively. Furthermore, the lack of normalization of the RBBB [HRa: 2.78 (95% CI: 1.05–7.31, p = 0.003)], of the NTW [HRa: 1.63 (95% CI: 1.04–2.55), p &amp;lt; 0.0001] and of the resolution of qR complex in V1 [HRa: 12.5 (95% CI: 3.39–46.4,) p &amp;lt; 0.0001] were independent predictors of poor prognosis in the short term. High–risk patients showing at the second–ECG the persitence of RBBB and NTWs as well as disappearance of the qR complex in V1 had a higher 30–day increased risk of death [HR: 9.44, (95% CI: 5.22–17.05, p &amp;lt; 0.0001]. The C–statistic confirmed in high–risk subjects an improvement in short–term prognostic power using the persistence of all three ECG signs (0.77, 95% CI: 0.51–0.94) or they single presence (0.61, 95% CI 0.42–0.79; 0.70; 95% CI: 0.52–0.88 and 0.74, 95% CI: 0.56–0.96, RBBB, NTWs and qR in V1, respectively). Conclusions The persistence of RBBB, NTWs, and qR pattern in V1 after 3 days from the hospitalization for acute PE represent an independent prognostic factors of death within 30 days in high–risk acute PE patients. In terms of prognostic power, the single evaluation of each ECG sign was lower compared to the overall or combined assessment.

Albumin levels predict mortality in sepsis patients with acute kidney injury undergoing continuous renal replacement therapy: a secondary analysis based on a retrospective cohort study

BackgroundAlbumin (ALB) levels are negatively associated with mortality in patients with sepsis. However, among sepsis patients with acute kidney injury (AKI) undergoing continuous renal replacement therapy (CRRT), there has been no similar study on the correlation between ALB levels and mortality alone. This study tested the hypothesis that ALB levels are negatively associated with mortality among such patients.MethodsWe conducted a secondary analysis of 794 septic patients who were diagnosed with AKI and underwent CRRT in South Korea. For the Kaplan–Meier survival analysis, Cox proportional hazards models were used to study the hypotheses, with adjustments for the pertinent covariables. We also explore the possible nonlinear relationship and conducted sensitivity analyses including subgroup analyses and tests for interactions to investigate the association further. Additionally, ALB was used to construct model and we then compared the performance of ALB with that of APACHE II and SOFA in predicting mortality.ResultsThe ALB level was an independent prognostic factor for death at 28 and 90 days after CRRT initiation (HR = 0.75, 95% CI: 0.62–0.90, P = 0.0024 for death at 28 days and HR = 0.73, 95% CI: 0.63–0.86, P < 0.0001 for death at 90 days). A nonlinear association was not identified between ALB levels and the endpoints. Subgroup analyses and tests for interactions indicated that HCO3 and CRP played an interactive role in the association. ROC analysis indicated ALB, SOFA and APACHE-II were separately inadequate for clinical applications.ConclusionA 1 g/dL increase in ALB levels was independently associated with a 25 and 27% decrease in the risk of death at 28 and 90 days, respectively. However, this conclusion needs to be taken with caution as this study has several limitations.

Predictors and Treatment Outcomes of Pediatric Osteosarcoma in Diverse Socioeconomic Backgrounds in Southeast Asia: A Retrospective Multicenter Study.

Background:Pediatric osteosarcoma outcomes among developed and developing countries have not been previously compared. Countries in Southeast Asia (SEA) have a wide variety of socioeconomic statuses. A multi-institutional retrospective study was conducted to determine the prognostic factors and outcomes for pediatric osteosarcoma in SEA. Methods:Pediatric patients with osteosarcoma treated between 1998 and 2017 in 4 SEA pediatric oncology centers were studied. Countries were classified using the World Bank Atlas method. Kaplan–Meier method and Cox’s Proportion Hazard Model were applied to estimate survival outcomes and identify prognostic factors. Results:In all, 149 patients with osteosarcoma with a mean age of 12.48±3.66 years were enrolled. The localized to metastatic disease ratio was 1.5:1. The 5-year overall survival (OS) and event-free survival (EFS) were 53.8% and 42%, respectively. Prognostic factors associated with outcomes were country, stage of disease, MTX-containing regimens, and surgery type (p-value <0.05). In patients with localized disease, EFS was superior with limb-salvage surgery (62%) than amputation or rotationplasty (40%) (p-value 0.009). MTX-containing chemotherapies provided higher OS (45.3%) and EFS (37.9%) than non-MTX regimens (12.3% and 10.7%, respectively) among metastatic patients (p-value 0.004 and 0.005, respectively). Metastatic disease was an independent prognostic factor for death but not relapse outcome. Conclusion:The disease outcomes in SEA were acceptable compared to developed countries. The stage of disease was the only independent prognostic factor. MTX-containing regimens and limb-salvage surgery should be considered where possible.

Prognostic Value of Stress Hyperglycemia in Patients Admitted to Medical/Geriatric Departments for Acute Medical Illness.

IntroductionHyperglycemia is common in patients admitted to Italian medical/geriatric units and is associated with a poorer outcome. We tested the significance of diabetes and stress-induced hyperglycemia in clinical outcome.Materials and MethodsThree hundred seventy-eight consecutive patients with hyperglycemia at entry (≥ 126 mg/dl) (206 without known diabetes) were included, with a wide range of underlying diseases requiring hospital admission and independent of the presence of diabetes. Relative hyperglycemia was calculated as admission glucose divided by average glucose, estimated based of glycosylated hemoglobin. Values ≥ 1.20 were considered indicative of stress hyperglycemia (SHR). The association of SHR with outcome variables (all-cause complications, infections, non-infectious events, deaths) was tested by logistic regression analysis, adjusted for sex, BMI, age-adjusted comorbidities (Charlson index) and known diabetes.ResultsDuring hospital stay, one or more events were registered in 96 patients (25.4%); 44 patients died in hospital, and fatality rate was borderline higher in patients without diabetes (14.6% vs. 8.1% in diabetes; P = 0.052) and nearly three times higher in patients with stress hyperglycemia (15.0%) vs. those with SHR < 1.2 (P = 0.005). Stress hyperglycemia—more common in the absence of diabetes (71% vs. 58%)—and age were the only independent prognostic factors for death. At multivariable analysis, the risks of death (OR 4.31, 95% CI 1.25–14.81), of all complications (OR 5.90, 95% CI 2.22–15.71) and of newly developed systemic infections (OR 5.67, 95% CI 1.61–19.92) were associated with stress hyperglycemia in subjects without diabetes, as was the risk in non-insulin-treated cases (OR 4.02, 95% CI 1.16–13.92; OR 5.47, 95% CI 2.21–13.52; OR 5.15, 95% CI 1.70–15.62, respectively).ConclusionThe study confirms the prognostic value of stress-related hyperglycemia in patients requiring hospital admission to a geriatric/medical unit for a variety of acute medical conditions, contributing to adverse outcomes not limited to events commonly associated with hyperglycemia (e.g., infections).Supplementary InformationThe online version contains supplementary material available at 10.1007/s13300-021-01183-y.

Clinical characteristics of macrophage activation syndrome in adult-onset Still's disease.

Macrophage activation syndrome (MAS) is considered the most severe complication of adult-onset Still's disease (AOSD). This retrospective observational study was conducted to explore the clinical characteristics of AOSD-MAS patients, the risk factors for MAS in AOSD and prognostic factors in AOSD. Early changes in the clinical characteristics of AOSD-MAS were also studied. 111 hospitalised AOSD patients were included in this retrospective analysis and analysed for the features of AOSD-MAS, selecting independent risk factors associated with MAS and the correlations between clinical characteristics and patient survival. Nine subjects (8.1%) developed MAS. AOSD-MAS patients had a higher incidence of jaundice (33.3% vs. 2.9%, p=0.007) and aspartate aminotransferase (AST) greater than 5-fold (33.3% vs. 2.9%, p=0.007). Jaundice was associated with an increased risk of MAS (OR=16.50, 95% CI: 2.73-99.82, p=0.002). The AOSD-MAS group had a higher mortality rate (55.6% vs. 8.0%, p=0.001). MAS (HR=11.22, 95% CI: 3.46-36.38, p<0.001), and white blood cell (WBC) greater than 20 109/L (HR=5.80, 95% CI: 1.09-30.92, p=0.040) were independent prognostic factors for death in AOSD patients. In the AOSD-MAS group, transaminase, triglycerides (TGs) and serum ferritin (SF) were elevated in the early disease stage, sometimes earlier than changes in blood cells in MAS. MAS occurrence significantly reduced the survival rate of patients with AOSD. The presence of jaundice was associated with MAS occurrence. MAS and a WBC count >20 109/L were associated with a high risk of AOSD-related death. AOSD should alert the possibility of MAS when elevated transaminase, TGs and SF cannot be explained.

Mortality prediction using clinical and laboratory features in elderly patients with severe community-acquired pneumonia.

Severe community-acquired pneumonia (SCAP) is a serious health threat in elderly individuals, and a prospective, observational study was conducted to explore the prognostic factors. Patients (≥65 years old) with SCAP that had an intensive care unit (ICU) stay >24 h were recruited at our center. Clinical and laboratory data were collected and various assessment scores were calculated. The follow-up period was censored at the date of death or at hospital discharge, whichever came first. A total of 120 elderly patients with SCAP were included. Among them, 61 were cured (survival group) and 59 died due to SCAP (mortality group). Multivariate logistic regression analysis showed that chronic obstructive pulmonary disorder (COPD, β=2.061, P=0.008) and CD3+CD4+ T cell count (β=-0.019, P=0.017) were independent prognostic factors for death in elderly patients with SCAP. The area under the receiver operating characteristic (ROC) curve (AUROC) for the age- and gender-adjusted model was estimated to be 0.915 [95% confidence interval (CI): 0.858-0.972] for mortality, and the sensitivity and specificity of the model were 91.53% and 86.89%, respectively. Our findings suggest that COPD and the CD3+CD4+ T cell count are independent prognostic factors for mortality, and the constructed model was moderately accurate in the prediction of mortality for elderly patients with SCAP.

Incidence and impact of acute cardiorenal syndrome

Abstract Funding Acknowledgements Type of funding sources: None. Background Acute (or type 1) cardio-renal syndrome (ACRS) is defined as the acute kidney injury in patients hospitalized for acute heart failure (HF), which often is associated to a complex and complicated clinical course. In addition, renal failure is a strong predictor of long-term adverse events in patients with acute heart failure (HF). Purpose To investigate the impact of ACRS, what factors are related to its occurrence, and how it affects the outcome of patients hospitalized with acute HF. Methods We studied consecutive patients hospitalized with acute HF from January 2019 to December 2020. Renal function as well as other biomarkers were recorded and monitored during hospitalization, and correlated with various clinical characteristics, risk factors and patient outcome. Results The sample consists of 612 patients, mean age 77 ± 12 years, 63% men with average duration of hospitalization 6 ± 4 days. A total of 37 deaths (6%) were observed. ACRS was found in 141 patients (23%) and independent prognostic factors for its occurrence were ischemic cardiomyopathy, age, prolonged hospitalization, use of aldosterone antagonists and high CRP upon admission. The incidence of ACRS during hospitalization was an independent prognostic factor of death (r = 0.15, p = 0.02) and anemia (r = 0.24, p = 0.04), while the outcome of death was more common in patients with ACRS - but without statistical significance - compared to patients without ACRS. Conclusion Deterioration of renal function in acute HF is associated with anemia and death. Factors such as ischemic cardiomyopathy, age, length of hospital stay seem to play a role in the onset of ACRS and should be taken into account in these patients, to prevent negative outcomes.

Association between tachyarrhythmia and mortality in a cohort of critically ill patients with coronavirus disease 2019 (COVID-19).

BackgroundCardiovascular involvement manifesting as arrhythmias has been confirmed in patients with coronavirus disease 2019 (COVID-19), so we aimed to explore the association between primary tachyarrhythmia and death in critically ill patients with COVID-19 in this retrospective study.MethodsA total of 79 critically ill patients with COVID-19 were included. Demographic characteristics, clinical data (past history, vital signs, therapeutic management, and outcomes), and results of laboratory findings and cardiac investigations were collected. All statistical analyses were performed using SPSS 23.0 software (IBM, Armonk, NY, USA).ResultsThe median age was 65±12 years, and 53 patients (67%) were male. A total of 57 (72%) patients died, and compared with survivors, these patients were older and had significantly higher Acute Physiology and Chronic Health Evaluation (APACHE) II score, Sequential Organ Failure Assessment (SOFA) score and fewer lymphocytes as well as higher heart rate (P<0.05). Autopsy findings did not suggest severe myocarditis. A total of 19 (24%) patients had tachyarrhythmias, including 10 (13%) with atrial fibrillation (AF) and 9 (11%) with ventricular tachycardia or fibrillation. The incidence of tachyarrhythmias in non-survivor was much higher than in survivors (P=0.04). In a Cox regression model, older patients with ventricular tachyarrhythmias (VTAs) age were at a higher risk of death, with hazard ratio (HR) of 3.302 [95% confidence interval (CI), 1.524–7.154, P=0.002] and 1.045 (95% CI, 1.020–1.071, P=0.000), respectively. The use of beta-blockers [HR, 0.219 (95% CI, 0.066–0.722); P=0.013] was associated with a lower risk of death.ConclusionsCritically ill patients with COVID-19 had a poor prognosis. VTA and older age were independent prognostic factors of death. Beta-blockers might be an effective therapy to improve survival.

Recurrence pattern and prognostic factors for survival in cervical cancer with lymph node metastasis.

The aim of this study is to evaluate the recurrence pattern and oncological outcomes in cervical cancer (CC) patients with lymph node metastasis. This study included 224 International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IB1-IIIB CC patients with pathologically proven lymph node metastasis. Surgical intervention was grouped as hysterectomy performed/not performed. Adjuvant therapy decision was made by the tumor board. Radiotherapy was applied to all patients with lymph node metastasis. Only paraaortic lymph node metastasis was determined as an independent prognostic factor for recurrence. Presence of paraaortic lymph node metastasis increased the risk of recurrence more than two times (odds ratio: 2.129; 95% confidence interval: 1.011-4.485; p=0.047). An independent prognostic factor for death because of disease was age only. Risk of death was nearly doubled with younger age (odds ratio: 2.693; 95% confidence interval: 1.064-6.184; p=0.037). The most of recurrences were located at distant sites and multiple regions. Paraaortic lymph node metastasis was the only independent prognostic factor for recurrence, in spite of that age was an independent predictor for risk of death in patients with early stage or locally advanced CC and also with surgically proven metastatic lymph nodes. Furthermore, the presence of the paraaortic lymph node metastasis was significantly associated with distant recurrence. Therefore, more appropriate and individualized therapy strategy focusing on intenser systemic chemotherapy options in addition to radiotherapy should be taken into consideration according to paraaortic lymph node metastasis and age.

Age, treatment and prognosis of patients with squamous cell vulvar cancer (VSCC) - analysis of the AGO-CaRE-1 study

BackgroundDespite an increasing incidence with simultaneous decreasing age of onset, vulvar squamous cell carcinoma (VSCC) is still a disease that mainly effects the elderly population. Data on the association of age with prognosis and treatment patterns in VSCC are sparse. MethodsThis is an analysis of the AGO-CaRE-1 cohort. Patients with VSCC (FIGO stage ≥1B), treated at 29 cancer centers in Germany from 1998 to 2008, were included in a centralized database (n = 1618). In this subgroup analysis patients were analyzed according to age [<50 yrs. (n = 220), 50–69 yrs. (n = 506), ≥70 yrs. (n = 521)] with regard to treatment patterns and prognosis. Only patients with documented age, surgical groin staging and known nodal status were included (n = 1247). Median follow-up was 27.5 months. ResultsAt first diagnosis, women ≥70 yrs. presented with more advanced tumor stages (<0.001), larger tumor diameter (<0.001), poorer ECOG status (<0.001), more frequent HPV negative tumors (p = 0.03) as well as a higher rate of nodal involvement (<0.001). Disease recurrence occurred significantly more often in elderly patients (p = 0.001) and age as well as ECOG status, microscopic residual resection, tumor stage, grading, and (chemo)radiation were independent prognostic factors for death or recurrence in multivariate analysis. 2-year disease-free survival rates were 59.3% (≥70 yrs), 65.8% (50–69 yrs) and 81.1% (<50 yrs), respectively (p < 0.001). ConclusionsOlder women with VSCC present with advanced tumor stages at first diagnosis and have an increased risk of recurrence as well as a decreased 2-year DFS in comparison to younger patients. Potential reasons could be self-awareness and/or more aggressive tumor biology due to HPV independent disease.

Ten-year survival analysis of patients with primary Sjögren's syndrome in China: a national prospective cohort study.

Aims:To investigate the long-term survival of patients with primary Sjögren’s syndrome (pSS) in China.Methods:Patients with pSS who fulfilled the 2002 American–European Consensus Group classification criteria were prospectively enrolled from 2004 to 2011. Their baseline clinical, laboratory, and therapeutic data were collected. The primary endpoint was all-cause death by January 2018. The standard mortality ratio (SMR) was calculated by comparing with age-matched and sex-matched mortality data of the general population. Kaplan–Meier curves were obtained by time-to-event analysis. Univariate and multivariate Cox hazards regression analyses were performed to identify risk factors for mortality.Results:A total of 1054 patients were enrolled and 834 patients were followed up for a median of 94.8 months, with 48 confirmed deaths. The total SMR was 3.63 [95% confidence interval (CI) 2.60–4.66]. The 3-, 5-, and 10-year survival rates were 98.4%, 97.5%, and 92.9%, respectively. Infection, malignancy, and respiratory failure were the top three causes of mortality. We identified male sex [hazard ratio (HR) = 3.00, 95% CI 1.23–7.31], age at diagnosis ⩾50 years of age (HR = 7.69, 95% CI 3.01–19.62), thrombocytopenia (HR = 1.93, 95% CI 1.01–3.72), and interstitial lung disease (HR = 5.96, 95% CI 2.24–15.82) as the independent prognostic factors of death.Conclusions:The mortality rates of Chinese patients with pSS are higher than those of the general population. Male patients of elder age at diagnosis complicated with thrombocytopenia and interstitial lung disease might be suggestive for poorer survival and require closer follow up.

Abstract 16438: Combined Prognostic Significance of Heart Failure and Chronic Kidney D in Patients With Acute Myocardial Infarction. The Fast-mi Programme

Introduction: We assessed the interplay and potential cumulative effects of heart failure (HF) and chronic kidney disease (CKD) on one-year and 5-year outcomes in patients admitted for acute myocardial infarction (AMI). Methods: FAST-MI consists of 3 nationwide French surveys 5 years apart from 2005 to 2015, consecutively including STEMI and NSTEMI patients over 1-month periods. Using Cox regression, we analysed the association between CKD and non-fatal HF and death during the first year after discharge according to absence of HF, previous HF and acute stage HF. In those alive at 1 year, we also analysed the prognostic significance of admission for non-fatal HF after AMI and CKD on 5-year mortality. Results: Of 12,301 patients discharged alive, 7960 (64.7%) had normal renal function and no HF. Both CKD and type of HF were independent predictors of one-year death: one-year mortality was 3.6%, 14.3% and 24.5% in patients with no HF, acute stage HF, and prior history of HF, respectively. Within each group, mortality increased by increasing degree of CKD. In patients with no history of HF, CKD was a strong independent correlate of hospital admission for HF within one year of discharge: HR (95%CI) 1.33 (1.01-1.74), P=0.04 for CKD-EPI 30-60, and 1.76 (1.16-2.67), P=0.008 for CKD-EPI &lt;30, as was the case in patients with HF at the acute stage (Figure). Finally, in patients alive at 1year, both HF admission during the first year (adjusted HR 1.85, 1.42-2.39, P&lt;0.001) and CKD (HR 1,23, 1.04-1.47, P=0.02 and HR 1.86, 1.41-2.44, P&lt;0.001, respectively for moderate and severe renal dysfunction), were independent predictors of 5-year death. Conclusion: After AMI, CKD and HF are major independent prognostic factors for death and/or subsequent HF admission. Both are likely to be important therapeutic targets to improve long-term outcomes after AMI.

Serum neurofilament light chain at time of diagnosis is an independent prognostic factor of survival in amyotrophic lateral sclerosis.

The prognostic value of serum neurofilament light chain (sNfL), a biomarker of neurodegeneration, compared to other prognostic factors of amyotrophic lateral sclerosis (ALS) at the time of diagnosis, remains unclear. Sera from ALS patients were prospectively collected at the first diagnostic visit in our centre. sNfL levels were determined by single molecule array in 207 ALS patients and in 21 healthy controls. The prognostic value of sNfL was compared with that of other known clinical prognostic factors using a Cox regression model and multivariate analysis. Serum neurofilament light chain levels were higher in ALS patients than in controls (P<0.0001). Seven parameters were predictive of death in ALS: older age, bulbar onset, higher ALS Functional Rating Scale revised (ALSFRS-R) score, greater weight loss, lower maximal inspiratory pressure, forced vital capacity and higher sNfL levels. A Cox regression model showed that sNfL (P<0.0001), weight loss (P=0.040) and site at onset (P=0.048) were independent predictive factors of death. In a sub-cohort restricted to 139 patients with complete spirometry data, sNfL level (P<0.005) and forced vital capacity (P=0.022) were independent factors predictive of death. In a subgroup of 142 patients in whom ALSFRS-R score was available at several time points, sNfL levels positively correlated with ALSFRS-R rate of decline (r=0.571, P<10-12 ). Higher sNfL concentration is a strong and independent prognostic factor of death in ALS as early as the time of diagnosis.