Patients Mean Age Research Articles

Diagnostic efficacy of 68 Ga-PSMA-PET/CT scan as a single staging modality in prostate cancer: Evidence from a tertiary healthcare centre.

e17130 Background: To explore whether the new 68 Ga-PSMA-PET/CT (Gallium-68 prostate-specific membrane antigen positron emission tomography-computed tomography) scan could be used as a single imaging modality over conventional imaging. Methods: This was a prospective study, conducted in a urology outpatient department, included 169 of 285 registered patients after obtaining informed consent. Patients who had biopsy-proven prostate adenocarcinoma, PSA (Prostate-specific antigen) ≥ 10 ng/ml, and Gleason Grade sum ≥ 7, were enrolled from July 2019 to May 2023. They underwent multiparametric MRI (mpMRI) Technetium 99m-methyl diphosphonate(99mTc-MDP) bone scan, and CT or ultrasound for conventional staging, followed by 68 Ga-PSMA-PET/CT. Furthermore, we evaluated the diagnostic efficacy, sensitivity, and specificity of 68 Ga-PSMA-PET/CT with conventional imaging. Results: The mean age of patients was 65.5 years, and the median serum PSA was 23.08 ng/ml. Most patients (147) were high-risk, and 22 were intermediate-risk. Among them, 90 underwent robotic-assisted radical prostatectomy. PSMAPET/CT showed statistically significant superiority in detecting regional lymph node invasion (37.8% vs 18.3%), non-regional lymph node invasion (17.2% vs 5.9%), and bony metastasis (23% vs 16.5%). It had comparable efficacy to conventional imaging for seminal vesicle involvement and visceral metastasis. PSMA PET/CT upstaged N and M status in 10.6 % and 8.8% of patients, respectively. In these 8.8% of cases, patients experienced an upward stage migration which led to shift in the treatment approach from curative to palliative intent for these patients. Conclusions: 68 Ga-PSMA-PET/CT is superior to conventional imaging methods and improves detection of regional lymph node, bone, and distant metastases, enhancing staging accuracy for prostate cancer.

Differences in Clinical Features Between Osseous and Nonosseous Arteriovenous Fistulas in the Cavernous Sinus

BACKGROUND AND OBJECTIVES: Although the characteristics of osseous shunted pouches of cavernous sinus (CS) arteriovenous fistula (AVF) have recently been a focus of investigation, few studies have reported details of CS AVF possessing nonosseous shunted pouches. We therefore compared detailed characteristics between osseous and nonosseous AVFs in the CS. METHODS: A total of 31 patients who underwent rotational angiography in our department between 2012 and 2023 were reviewed. We divided anatomical shunted pouches into 3 types: extraosseous, intraosseous, and mixed. We analyzed and compared characteristics and treatment results between types. RESULTS: Of the 31 CS AVF patients, 14 showed extraosseous type, 10 showed mixed type, and 7 showed intraosseous type. The mean ages of patients with these types were 70.0 ± 7.9 years, 73.6 ± 8.5 years, and 76.9 ± 5.3 years, respectively, showing no significant differences. However, when limited to female patients, the mean ages were 68.3 ± 6.0 years, 75.1 ± 3.4 years, and 76.9 ± 5.3 years, respectively, showing significant differences among types. The number of single shunts was significantly lower with mixed type, and the incidence of cortical venous reflux was significantly lower with extraosseous type. Ten cases of extraosseous type (71%), 7 cases of mixed type (70%), and 5 cases of intraosseous type (71%) were treated with selective transvenous embolization of the shunted pouch. Ten extraosseous-type cases (71%), 5 mixed-type cases (50%), and 6 intraosseous-type cases (86%) were completely occluded by embolization. CONCLUSION: Restricted to women, high age was significantly associated with intraosseous-type CS AVF. Although significant differences were evident in the number of shunted pouches and incidence of cortical venous reflux among groups, treatment method did not depend on the type of CS AVF.

Outpatient crystalluria: prevalence, crystal types, and associations with comorbidities and urinary tract infections at a provincial hospital

Background and Objectives: Crystalluria refers to the occurrence of crystals in urine resulting from urinary supersatura- tion, which disrupts the balance between factors that promote and those that inhibit crystal formation in urine. This study aimed to assess the prevalence of crystalluria, identify crystal types, determine associated comorbidities, and assess links with bacterial urinary tract infections in outpatients at Hassan II Hospital in Settat. Materials and Methods: A retrospective study was conducted from January 2022 to May 2023 at Hassan II Hospital. Urine samples from patients suspected of urinary tract infections, who underwent cytobacteriological urine examinations, were analyzed. Results: Among 1,025 urine samples, 22.04% showed crystalluria. The mean age of patients was 51.3 with a standard de- viation of 18.1 years. The most common crystal types were calcium oxalate (46.4%), uric acid (23.5%), urates (15.1%) and struvite (9.3%). Comorbidities including, diabetes, kidney failure, prostatitis, and nephrotic syndrome was associated with urinary crystal formation. The prevalence of urinary tract infections in patients with urinary crystals was 10.6%. Struvite crys- tals were specifically associated with bacterial infections, especially with Proteus mirabilis, Escherichia coli, Citrobacter freundii, Citrobacter koseri, and Enterobacter cloacae. Conclusion: Monitoring urinary crystals is essential for preventing the formation of kidney calculi and crystal-associated infections, especially in high-risk individuals.

Endovascular Treatment and Hybrid Surgery for Extracranial Internal Carotid Artery Aneurysms.

Endovascular Treatment and Hybrid Surgery for Extracranial Internal Carotid Artery Aneurysms.

Phenotypic, genotypic characterization and antimicrobial resistance profiling of uropathogenic Escherichia coli in a tertiary care hospital, Puducherry, India

Background and Objectives: Uropathogenic Escherichia coli (E. coli) (UPEC) accounts for 70-95% of community-ac- quired urinary tract infections (UTIs) and a significant proportion of nosocomial UTIs. This study aimed to characterize the phenotypic and genotypic characteristics of E. coli isolates from symptomatic UTI patients and evaluate their antimicrobial susceptibility patterns. Materials and Methods: A hospital-based observational study was conducted at Aarupadai Veedu Medical College and Hospital, Puducherry, India, from August 2022 to April 2024. A total of 106 UPEC isolates were obtained from symptomatic UTI patients. Antimicrobial susceptibility testing (AST) was performed using the Kirby-Bauer method, and virulence genes (hlyA, fimH, papC) were detected using PCR. Results: The mean age of patients was 49.7 years, with a female predominance (69.8%). Diabetes mellitus was the most common comorbidity (29.2%). Fever (60.4%) and dysuria (38.7%) were the most common symptoms. AST showed high susceptibility (>90%) to amikacin, nitrofurantoin, meropenem, and piperacillin/tazobactam, while >60% resistance was ob- served to cefotaxime and ceftazidime. Phenotypically, 30.2% of the isolates produced mannose-resistant hemagglutinins, and 17.9% produced hemolysin. ESBL production was found in 46.3%. Biofilm production was moderate in 65.1%, weak in 30.2% and strong in 4.7% and significantly correlated with multidrug resistance (p<0.05). Genotypically, 80.2% had fimH, 51.9% had papC and 20.8% had hlyA. papC was associated with reduced cefotaxime susceptibility (p<0.05). Conclusion: The study highlights the significance of phenotypic and genotypic characterization in understanding UPEC virulence and resistance patterns, and emphasizes the need for targeted empiric therapy to improve UTI management.

Concurrent acute myeloid leukemia and chronic lymphocytic leukemia: A review and clinical insights.

e18513 Background: Chronic lymphocytic leukemia (CLL) is the most common indolent lymphoproliferative neoplasm in older adults, frequently associated with immunoglobulin deficiencies and secondary solid tumors. Acute myeloid leukemia (AML), characterized by the rapid proliferation of myeloid blasts, is a distinct hematological malignancy with poor prognosis in elderly patients. The simultaneous occurrence of AML and CLL in a single patient is exceedingly rare and presents unique diagnostic and therapeutic challenges. Recent advancements in genomic and molecular diagnostics have led to an increased number of documented cases. This review aims to evaluate reported cases of concomitant AML and CLL, analyzing clinical features, diagnostic findings, treatment strategies, and outcomes. Methods: A systematic review was conducted using available literature to identify cases of concurrent AML and CLL. Cases were analyzed for demographic data, hematological parameters, cytogenetic and molecular findings, treatments administered, and outcomes. Data from 43 patients with coexisting AML and CLL were included for detailed analysis. Results: The mean age of patients at presentation was 70 years (range 38–82), with a male predominance (70%). Presenting symptoms included fatigue (34%), anemia (21%), and weight loss (14%), while 9% of patients were asymptomatic. Hematological parameters revealed mean hemoglobin levels of 11 g/dL, WBC counts of 40 × 10³/µL, and platelet counts of 30 × 10³/µL. Cytogenetic analysis showed diploid karyotypes in 48% of cases, with deletions of chromosomes 7, 13, and 12 also reported. Molecular findings, although limited, included mutations in, CEBPA ASXL1, TET2, STAG2, and other genes. Treatments varied, with AML patients predominantly receiving 3+7 induction chemotherapy (32%), while CLL treatments included bendamustine-rituximab-venetoclax (13%). Overall mortality was high, with 54% of patients succumbing to disease progression or complications. Long-term follow-up data were scarce, with only 2 patients documented beyond 12 months. Conclusions: The coexistence of AML and CLL is an uncommon but clinically significant phenomenon that is often associated with poor outcomes with more less than 50 % survival over 12 months. The overlapping yet distinct pathophysiology of these diseases suggests mechanisms such as clonal evolution, genetic mutations, and immune dysregulation may play a role. Effective management requires a multifaceted approach, addressing the aggressive nature of AML and the profound immunosuppression linked to CLL. Further research into the underlying mechanisms and treatment strategies is essential to improve outcomes for patients with this dual diagnosis.

Carotid webs and stroke: a comprehensive overview of clinical characteristics, risk factors, and treatment modalities.

Carotid webs and stroke: a comprehensive overview of clinical characteristics, risk factors, and treatment modalities.

A comprehensive analysis of primary malignant brain tumors radiotherapy in a low-resourced country: A single-institution retrospective study.

e14035 Background: The purpose of this study is to investigate radiation treatment of primary malignant brain tumors in a country with limited resources and infrastructure, and make a general statistical analysis of patients and the prevalence of different types of tumors. Methods: This single-institution retrospective study examines patients with primary brain tumors treated at the Radiotherapy Department of the National Center of Oncology, the leading radiotherapy center in Armenia, where the vast majority of patients with such tumors receive their treatment. The study includes information on all patients presented in a 3-year period, from 2021 to 2023. The main variables examined were age, gender, residence, diagnosis and the type of machines used for radiotherapy with the daily dosage and number of fractions. Results: A total of 157 cases were included in the final analysis.The mean age of patients was 51 years. Male to female ratio was 1.2:1. 89 patients (56.7%) had urban residency. The most common types of brain tumors were different types of gliomas (73.9%), meningiomas (6.4%) and ependymomas (5.7%). 64.3% of patients had undergone total tumor resection before radiotherapy, 21.7% received radiotherapy after subtotal resection and 14.0% of patients hadn’t undergone any surgery. The mean daily dosage and mean fractions sessions were 1.9739 and 28.2166, respectively. The main radiotherapy machine used for treatment was 3D-CRT 6 MEV ELEKTA linear accelerator (94.9%), however, in some cases, 2D Co-60 Teragam radiotherapy machine (5.1%) was used. Only 50.3 % of patients are alive at the time of analysis. Conclusions: The results of this study show that the radiotherapy treatment of primary malignant brain tumors is still challenging in developing countries like Armenia. This research may help to comprehensively understand the main problems in organizing the treatment of primary malignant brain tumors.

Association of preablation tumor biopsy and long-term outcomes of colorectal liver oligometastases.

Association of preablation tumor biopsy and long-term outcomes of colorectal liver oligometastases.

Iliopsoas Abscesses: Whose Problem is it? Insights Gained by an Institutional 100-Patient Consecutive Case Series.

Iliopsoas Abscesses: Whose Problem is it? Insights Gained by an Institutional 100-Patient Consecutive Case Series.

Trends in lung cancer epidemiology and mortality over 12 years: Socioeconomic and demographic disparities.

8042 Background: Lung cancer (LC), the most common cancer worldwide, remains a significant health burden with high rate of incidence and mortality in the United States and worldwide. Studies show that Black patients are 15% less likely to obtain an early diagnosis and have lower 5-year survival compared to White patients. Methods: The National Inpatient Sample database (2010–2021) was analyzed to identify adult hospitalizations with LC as a primary or secondary diagnosis. Multivariate logistic regression assessed epidemiologic and mortality trends and their association with demographic factors. Results: A total of 1,462,998 hospitalizations were identified with LC between 2020 and 2021. Of these, 196,225 patients (13.4%, 95% CI: 13.2–13.6) received palliative care. For metastatic LC admissions (n = 574,935), 21.5% (123,577) received palliative treatment. In 2010, the mean patient age was 67.6 years, which went up to 69.1 years in 2021. The percentage of LC patients with age over 65 years increased from 62.7% to 68.3%, whereas for patients under 45 and those between 45 and 65 years old, the percentage decreased from 2.0% to 1.4%, and 35.3% to 30.3%, respectively. The percentage of women diagnosed with lung cancer increased from 47.1% to 52.3% in 12 years. From 2010-2021, overall mortality from LC decreased (OR 0.96, 95% CI: 0.95–0.96). However, mortality was found to be lower in females (OR 0.80, 95% CI: 0.78–0.82, p < 0.001), and higher in Blacks than Whites (OR 1.07, 95% CI: 1.02–1.17, p = 0.003), and higher in those over 65 than in those between the ages of 18 and 45 (OR 1.11, 95% CI: 0.99–1.24, p = 0.063). Mortality rates were greater among Black people across all genders. While age-related differences were not significant among females, older age was linked to higher mortality among males (OR 1.15, 95% CI: 0.99–1.34, p = 0.066). Across all ethnicities, the death rate was consistently lower for females. Only White people showed substantial variations in age-related mortality, with older patients having higher mortality. Mortality rates within the lowest income bracket were the same for any age and ethnic group. Conversely, Black people had a higher mortality rate than White people in the highest income category (OR 1.24, 95% CI: 1.08–1.41, p = 0.002). Conclusions: Over the years, while LC mortality has decreased overall, disparities persisted with Black patients showing higher mortality compared to Whites, even in the higher income brackets. Increased mortality was associated with older age and male gender. These findings highlight the need for targeted interventions to address racial, gender, and socioeconomic disparities and to improve the survival of the identified high-risk population, especially minorities.

Identifying key prognostic indicators in Wilms tumor using machine learning techniques.

4557 Background: Wilms tumor is a rare pediatric malignancy, accounting for 6% of pediatric tumors and primarily affecting the kidneys. Its impact on quality of life and long-term outcomes complicates management. This study leveraged machine learning (ML) to identify prognostic factors with the aim of enhancing prognosis and survival rates. Methods: Data were obtained from the SEER database (2004-2021). Patients who met any of the following criteria were excluded: diagnosis not confirmed by histology, previous history of cancer or other concurrent malignancies, or unknown data. To identify prognostic variables, we conducted Cox regression analysis and constructed prognostic models using ML algorithms to predict the 5-year survival. Patient records were randomly divided into training (70%) and validation (30%) sets. A validation method incorporating the area under the curve (AUC) of the receiver operating characteristic curve was used to validate the accuracy and reliability of the ML models. We also investigated the role of multiple therapeutic options using Kaplan-Meier survival analysis. Results: A total of 4,935 children were included. Among them, 47.72% underwent surgery, radiation, and chemotherapy; 45.07% underwent surgery and chemotherapy; and 7.21% underwent surgery alone. Most patients (53.3%) were females, 75% were white, followed by black (16.3%). The mean patient age was 3 years, and the mean tumor size was 10.6 cm. Most tumors were left-sided (51.1%) and 79.8% had no metastasis. The lungs were the most frequent site of metastasis (11%), followed by the liver and lungs at the same time (1.2%), and bone involvement was rare (0.6%). Radical surgery was the most common surgical approach (76.1%), followed by nephrectomy (4.9%). Patients who underwent surgery and chemotherapy had the highest 5-year OS (96.9%) and CSS (96.9%) compared to those who underwent surgery alone (OS: 95.5%, CSS: 95.5%) or surgery with chemotherapy and radiation (OS: 92.9%, CSS: 93.2%). Asian/Pacific Islander and white patients exhibited better OS (94.3% and 95.1%, respectively) than black patients (91.9%). Multivariate Cox regression analysis identified a large tumor size and older age as poor prognostic factors. Gradient boosting and MLP classifiers were the most accurate models. The ML models identified race as the most significant prognostic factor, followed by the TNM stage and age. The performance metrics for all ML algorithms are summarized in Table. Conclusions: This is the first study to apply ML to Wilms tumor, effectively identifying key prognostic factors. ML models show promise in enhancing survival predictions, potentially informing personalized treatment strategies, and improving patient outcomes. ML Model Accuracy Precision Recall F1 score AUC LR 59.5% 59.5% 99.6% 74.5% 0.573 KNN 56.1% 61.7% 68.7% 65.05% 0.572 RFC 59.9% 61.9% 84.4% 71.4% 0.596 GBC 60.7% 60.5% 97.3% 74.6% 0.582 MLP 60.9% 61.6% 90.5% 73.3% 0.589

Longitudinal Urine Drug Testing Among Patients Receiving Opioids for Cancer Pain.

Longitudinal Urine Drug Testing Among Patients Receiving Opioids for Cancer Pain.

Opioid use disorder among females with breast cancer: A comprehensive analysis of prevalence in the United States and associated factors.

1118 Background: Patients with breast cancer (BC) are frequently prescribed opioids for pain management, placing them at risk of opioid use disorder (OUD). This study analyzes the prevalence of OUD and identifies factors contributing to its risk among BC patients in the United States. Methods: We conducted a retrospective analysis using the National Inpatient Sample (NIS) database, a Healthcare Cost and Utilization Project (HCUP) component. Females with BC were identified through ICD-10 codes. The Cochran-Armitage trend test assessed OUD prevalence trends from 2016 to 2022. Multivariable regression models estimated the impact of multiple patient demographics and comorbidities on the presence of OUD. Results: Among 1,189,884 females aged≥18 with BC, 2.3% (27,500) had OUD. The mean age of OUD patients was 58.38 years, compared to 64.46 years in the non-OUD cohort. OUD prevalence was highest in those aged 18–50 years (3.8%), followed by 51–60 years (3.0%), and lowest in those > 60 years (1.7%). Between 2016 and 2020, OUD prevalence increased from 1.9% to 2.8%, followed by a decline to 2.4% in 2022 (p-trend < 0.01). Factors that were linked with higher OUD involved patients with neoplasm-related pain(NRP)(aOR 5.718, 95% CI 5.549-5.893, p < 0.01), on palliative care (aOR 1.397, 95% CI 1.353-1.443, p < 0.001), with metastasis (aOR 1.573, 95% CI 1.526-1.621, p < 0.01), depression (aOR 1.447, 95% CI 1.400-1.495, p < 0.01), bipolar disorder (aOR 2.173, 95% CI 2.038-2.317, p < 0.01), suicidality (aOR 3.228, 95% CI 2.938-3.546, p < 0.01), and anxiety (aOR 1.617, 95% CI 1.572-1.664, p < 0.01). Moreover, substance use such as cocaine (aOR 5.252, 95% CI 4.708-5.859, p < 0.01) and amphetamine (aOR 3.948, 95% CI 3.443-4.527, p < 0.01) was also associated with higher odds, while cannabis users (aOR 0.876, 95% CI 0.793-0.968, p < 0.01) had lower odds of OUD. Our study further found racial disparities, with reduced odds among Blacks ( vs Whites, aOR 0.933, 95% CI 0.901-0.967, p < 0.01) and Hispanics (vs.Whites, aOR 0.866, 95% CI 0.827-0.906, p < 0.01). Socio-economic differences were also noted, with lower odds among those of the 26th-50th (vs. 0-25th, aOR 0.932, 95% CI 0.9-0.966, p < 0.01), 51st-75th (vs. 0-25th, aOR 0.951, 95% CI 0.918-0.986, p < 0.01), and 76th-100th (vs. 0-25th, aOR 0.916, 95% CI 0.882-0.951, p < 0.01) household income quartiles. Conclusions: This study showcases the significant prevalence and impact of OUD among BC patients, identifying socioeconomic and racial disparities, and key risk factors such as NRP, psychiatric comorbidities, and concurrent substance use, like cocaine and amphetamines. Interestingly, cannabis use was associated with a lower risk of OUD, which may reflect its role as an alternative pain management strategy. Overall, this study suggests the need to adopt crucial preventative measures against OUD in patients exhibiting these characteristics.

Comparative analysis of health disparities in prostate cancer patients with and without venous thromboembolism, and with and without anticoagulation therapy.

e17162 Background: Venous thromboembolism (VTE) in cancer is a commonly observed clinical complication. The risk of VTE is high in prostate cancer when compared to men without prostate cancer. Methods: We conducted a retrospective analysis using the 2022 NIS database to examine health disparities in prostate cancer patients with DVT and PE. Patients were categorized into groups based on the presence or absence of DVT, PE, and whether or not they were on anticoagulation, with no prior venous thrombosis. Health disparities, including length of stay, total charges, age, and mortality, were analyzed using chi-square and t-tests, with p<0.05 considered significant. Results: A total number of 163,468 patients were identified with a diagnosis of prostate cancer. Out of this, a total of 10,129 were identified with DVT, 14,420 with PE, and 13,695 patients on anticoagulation with no prior VTE history. Patients with DVT had a higher percentage of mortality (14.28%) compared to those without DVT (8.82%) with chi2= 3556.6, p=0.00. Similarly, prostate cancer patients with PE had a higher percentage of mortality (10.8%) compared to those without PE (8.9%) with chi2= 2549.4(p = 0.00). The mortality rate of patients with and without anticoagulation was 7.1% vs 8.7% (p= 0.00). The mean age of prostate cancer patients who were hospitalized with DVT was 64 years, 65 years in PE, and 70 years in patients with anticoagulation. There was no statistically significant difference in the mean total charges between patients with PE (M = $94,603.37, SD = 130,494.3) and without PE (M = $94,838.35, SD = 129,395) with p=0.84. However, patients with DVT had significantly higher mean total charges during hospitalization (M = $137,298.40, SD = 208,128.1) compared to those without DVT (M = $92,015.77, SD = 122,026.7), with a t (163461) = 34.05, p < 0.00. DVT was associated with increased length of stay (M = 9.6 days, SD = 9.46) compared to without DVT (M = 6.6 days, SD = 7.63) with a t (163461) = 37.67, p < 0.00. PE was associated with prolonged length of stay (M = 7.2 days, SD = 8.2) compared to without PE (M = 6.7 days, SD = 7.8) with t(17,056) = 6.01, p< 0.00. The patients on anticoagulation had lower total charges during hospitalization than those without ($76475.5 vs $94045.5 with p<0.00) and slight variation in their Length of stay (6.1 vs 6.6 days with p<0.00). Conclusions: Venous thromboembolism was significantly associated with higher total charges (except PE), length of stay, and mortality in prostate cancer patients. The anticoagulated patients were noted to have low mortality rates, total hospitalization charges, and length of stay. Therefore, preventing venous thromboembolism may decrease healthcare utilization and mortality in these patient populations. This analysis suggests that prophylactic anticoagulation in these patients may be an area of future research.

Outcomes and predictors of chronic graft-vs-host-disease in bone marrow transplant recipients.

e18552 Background: Chronic graft-versus-host disease (GVHD) affects approximately 20-40% of transplant recipients. It is a complication mediated by allogeneic T and B cells from the graft, which attack the genetically distinct tissues of the host. Chronic GVHD can significantly impact the outcome in patients undergoing bone marrow transplant (BMT) in terms of overall survival (OS) and progression-free survival (PFS) by increasing the risk of infections, graft failure, and multi-organ dysfunction. This study aims to analyze the outcome and predictors of chronic GHVD in patients undergoing BMT. Methods: We used the National Inpatient Sample database from 2016 to 2020, along with ICD-10 codes, to conduct a retrospective analysis and identify patients aged 18 and older who underwent BMT. The study assessed the impact of chronic GVHD on mortality, morbidity, and resource utilization in BMT patients. A chi-square test was used to analyze predictors of GVHD in BMT patients. Multivariate analysis, adjusted for confounders, was conducted to calculate the odds ratios for outcomes in BMT patients with GVHD. All weighted analyses were carried out using STATA MP 17.0. Results: 243,684 patients who underwent BMT were identified. Of these, 10.64% developed chronic GVHD. The mean age of BMT patients with chronic GVHD was 53.3 years, compared to 58.45 years for those without chronic GVHD. 43% of BMT patients with chronic GVHD were female, and 74% were white, 7% were Black, and 10% were Hispanic (p<0.001). Multivariate analysis, after adjusting for confounders, showed increased odds of mortality (Odds Ratio [OR]: 1.70, 95% Confidence Interval [CI]: 1.50-1.91, p<0.001), sepsis (OR: 1.34, CI: 1.23-1.45, p<0.001), and total hospital charge (Beta coefficient: $55,396, CI: $43,562-$67,230, p<0.001) in BMT patients who developed chronic GVHD compared to those without. A chi-square test analyzed the predictors of developing chronic GVHD in BMT patients (Table 1). Conclusions: Chronic GVHD affects approximately 1 in 10 BMT patients, and significantly increases total hospital charge , risks of death and infections like sepsis. Patients with chronic GVHD tend to be slightly younger and vary by race and gender. These findings highlight the importance of identifying high-risk patients and improving preventive strategies as prevention of chronic GVHD has more success than treatment Advances in conditioning regimen and treatment have improved outcomes in recent years, but chronic GVHD remains a major contributor to transplant-related mortality. Chi-square analysis showing predictors of developing chronic GVHD in BMT hospitalizations. Predictors with GVHD(%) without GVHD (%) p-value Sepsis 16.53 13.22 <0.001 Alcohol use 7.1 1.1 0.01 Liver disease 4.22 3.43 0.007 Diabetes 26.71 22.14 <0.001 Malnutrition 4.72 2.39 <0.001

Multiple myeloma as a predictor of in-hospital outcomes in ESRD patients: A nationwide analysis.

e23068 Background: Multiple Myeloma (MM) has a 3-year survival rate of about 60% in frail patients. It is a precursor to acute kidney injury and chronic kidney disease progression, particularly in patients with high tumor burden, potentially leading to end-stage renal disease (ESRD). Emerging treatments have shown promising results in reversing kidney disease progression in some cases of MM, making it essential to identify the role of MM in the outcomes of ESRD. However, limited research is available regarding the in-hospital outcomes of ESRD patients with MM. This study aims to assess the impact of MM in hospitalized ESRD patients. Methods: A retrospective analysis was conducted using the National Inpatient Sample database from 2016 to 2020 and ICD-10 codes were used to identify adult hospitalizations of ESRD. We evaluated the effect of MM on mortality, morbidity, and resource utilization in patients with ESRD. Categorical variables were compared using chi-square test, while continuous variables were compared using t-test. Multivariate analysis, adjusted for confounders, was conducted to derive the odds ratio, and all weighted analyses were carried out using STATA MP 17.0. Results: A total of 5,549,620 ESRD hospitalizations were identified. Of these, 1.1% were diagnosed with MM. The mean age of ESRD patients with MM was 68 years, and 41% of them were female. Additionally, 41.1% of ESRD patients with MM were from the Southern region of the U.S., nearly double the percentage from other regions. After adjusting for confounders, ESRD patients with MM had higher odds of mortality and worse outcomes compared to those without MM (Table). MM with ESRD was also associated with higher resource utilization, including a longer length of stay by 1.4 days and higher hospital charges by $10,377. Conclusions: MM independently portends worse outcomes in ESRD hospitalizations, highlighting the need for targeted treatments aimed at reversing disease progression. ESRD patients with MM should be treated as a unique group with risk-specific outcomes contrary to other ESRD patients, emphasizing the need for further prospective studies to establish causation. Chi-square and multivariate regression analysis showing impact of MM on ESRD hospitalizations. Outcomes with MM(%) without MM(%) Adjusted Odds Ratio* 95% Confidence Interval p-value Mortality 7.8 5.1 1.26 1.18-1.35 P<0.001 Sepsis 13.4 10.9 1.16 1.09- 1.22 P<0.001 Fluid Overload 8.31 10.1 0.90 0.84-0.97 P<0.001 Thrombosis 5.6 4.1 1.27 1.17-1.39 P<0.001 ICU admission 0.5 0.7 0.60 0.46-0.77 P<0.001 Anemia 84.0 76.0 1.76 1.67-1.85 P<0.001 Thrombocytopenia 21.0 9.4 2.43 2.32-2.55 P<0.001 Hyperkalemia 22.4 26.5 0.90 0.86-0.94 P<0.001 *Adjusted for patient and hospital level characteristics, baseline demographics and confounders.

The impact of neoadjuvant chemotherapy (NAC) ± anti-HER2 antibodies (mAbs) on gut microbiome composition in early breast cancer (EBC): A pilot prospective study.

e12626 Background: Gut microbiome composition and its changes induced by chemotherapy ± anti-HER2 monoclonal antibodies (mAbs) in breast cancer patients are poorly recognized. We assessed gut microbiome composition before and after NAC ± anti-HER2 mAbs in early breast cancer (EBC). Methods: Stool samples were collected by patients at home using a collection kit (OMR-200 (Diversigen). Samples were extracted using the Qiagen PowerSoil Pro kit. Paired-end whole-genome shotgun sequencing was performed to a depth of at least 2M reads per sample. Bacteria were identified from the sequences using the Cmbio HUB Kepler pipeline. Community differences by treatment group were analyzed by calculating alpha and beta diversity indices along with differential abundance and regression analysis using the tool MaAsLin2. Chi-square, Fisher’s exact test, and Wilcoxon rank-sum tests were used to compare demographic variables (age, diet, use of probiotics and/or antibiotics before and during chemotherapy, granulocyte growth factors for prophylaxis and in case of neutropenic fever, gastrointestinal symptoms during therapy). Results: We analyzed 55 samples from 29 Caucasian patients (mean age of 53 years, range 31–81), including luminal HER2-positive (n = 3), non-luminal HER2-positive (n = 9), triple negative (n = 10), and luminal HER2-negative (n = 7) cases. 26 samples paired before and after neoadjuvant therapy: included 11 NAC + anti-HER2 mAbs: AC/PHPXL (doxorubicin (A), cyclophosphamide (C), pertuzumab (P), trastuzumab (H), paclitaxel (PXL), P/H/PXL and carboplatin (CARB) and 15 NAC alone: AC followed by PXL ± CARB. All regiments with standard premedication with steroids and ondansetron. We excluded 3 patients who received pembrolizumab from the analysis. In patients administered NAC alone, no significant differences were found between alpha and beta diversity and their relation with pathological complete (pCR) or non-complete response (non-pCR). In turn, NAC + anti HER2 mAbs induced changes in microbiome composition, which were related with response: Actinomycetota showed a correlation with pCR (false discovery rate , FDR 2.110e−01; coefficient: 2.14e+00; p = 0.023) and Methanobacteriota with non-pCR (FDR 2.110e−01; coefficient: −6.02e−01; p = 0.021). Increased abundance of Coprococcus eutactus was associated with non-pCR (FDR: 2.528e-03 ratio: -3.77e+00; p = 0.002). Conclusions: Our data show that NAC + mAbs, as opposed to NAC alone, impacts the composition of the microbiome, which correlates with pathological response. Coprococcus eutactus increased abundance in HER2-positive EBC patients with non-pCR after NAC + anti HER2 mAbs needs further investigation.

Epicardial adipose tissue in patients with and without COVID-19 infection.

Acute COVID-19 infection frequently affects the cardiovascular system and causes acute myocardial injury. Epicardial Adipose Tissue (EAT), a visceral adipose tissue surrounding the myocardium and coronary arteries, has unique paracrine and endocrine effects, modulating the heart's inflammatory environment. Systemic inflammation stimulates TNF-α and Interleukin-6 secretion from EAT, contributing to cytokine storms and intensifying systemic responses. We aimed to determine whether EAT amount differs in patients with and without acute COVID-19 infection and myocardial injury. This study analyzed the CoV-COR registry cohort, conducted at the University Hospital Essen, including patients with symptoms suggestive of COVID-19 infection. The infection was confirmed by PCR. EAT thickness was measured by two-dimensional TTE. A total of 296 patients (mean age 63.6±17.26years, 55.4% male) were included. Patients with confirmed COVID-19 infection were younger, more frequently treated with antihypertensive medication, and had higher BMI and systolic blood pressures. Univariate logistic regression showed no association between EAT and myocardial injury 0.97 (0.74; 1.28, p=0.82). A trend towards an association was observed between increasing EAT thickness and COVID-19 infection 1.25 (0.99; 1.59, p=0.060). Adjusting for age and gender strengthened the association, with a 48% (1.14; 1.93, p=0.004) increased odds of COVID-19 infection per increase in EAT thickness. Multivariable regression yielded consistent effect sizes 1.47 (1.01; 2.16, p=0.047). EAT thickness is associated with the presence of an acute COVID-19 infection but not with a myocardial injury. Further research is needed to assess if systemic viral infection induces dynamic changes in EAT.

Utilization and impact of a digital care platform on cancer patients in India.

1576 Background: Cancer patients experience complex symptoms and treatment-related side effects that impair quality of life (QoL) and increase healthcare utilization. Digital health tools have the potential to improve symptom management and patient outcomes by facilitating real-time communication and support, especially for patients with limited access to immediate care. This study aimed to assess the usability and impact of a digital cancer care platform (Alivius) among Indian cancer patients, their primary caregivers, and care teams. Methods: We conducted a prospective, interventional, real-world study at a single tertiary cancer center in India from Jan 30, 2024, to Jun 11, 2024. We enrolled 100 cancer patients aged 18–80 years who had access to a smart phone, can read English, had a confirmed cancer diagnosis and had undergone at least one cycle of chemotherapy or radiotherapy. Patients were asked to communicate their symptoms and concerns to the care team and got health education materials for their disease. Primary endpoints included the Monthly Active Users (MAU) and Net Promoter Score (NPS) a metric used to measure customer loyalty and satisfaction by asking customers how likely they are to recommend a company or product. Secondary endpoints included the number of chat interactions, patient-logged symptoms, and use of educational content. Data were collected through in-app user activity and user feedback surveys. Descriptive statistics summarized the data with chi-square test for categorical variables and t-tests or non-parametric tests for continuous variables. Results: Out of 100 registered patients (mean age 58.7 ± 12.5 years; 61% male), the majority had gastrointestinal (55%) and genitourinary (18%) cancers. 66 caregivers participated in survey, with 84.8% being immediate family members. Average MAU during the study period was 58. The NPS for recommending the hospital and the digital application was 30.9 and 32.4 respectively, indicating positive user perception. User engagement was high during the study period: 85% accessed educational content, 82% updated health status, and 78% tracked mood. A total of 2,825 app activities were recorded, including 888 health status updates and 436 chat interactions. 507 side effects alerts generated, 29.5% were high severity, primarily related to tiredness and fatigue (29.2%), gastrointestinal issues (27.2%), and pain (17.5%). Customer Satisfaction Score (CSAT) was 50 and 48.5 among care teams (Doctors & Nurses) and patients, respectively. The app facilitated real-time communication between patients, caregivers, and care teams. Conclusions: Digital platform demonstrated high user engagement and positive perceptions among both the patients and their caregivers. The app effectively facilitated communication, symptom tracking, and management of treatment side effects. Patient centered digital platforms hold promise for improving cancer care support.