Modified Charlson Comorbidity Index Score Research Articles

Outcomes of breakthrough COVID-19 infections in patients with hematologic malignancies

AbstractPatients with hematologic malignancies have both an increased risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and higher morbidity/mortality. They have lower seroconversion rates after vaccination, potentially leading to inferior coronavirus disease 2019 (COVID-19) outcomes, despite vaccination. We consequently evaluated the clinical outcomes of COVID-19 infections in 243 vaccinated and 175 unvaccinated patients with hematologic malignancies. Hospitalization rates were lower in the vaccinated group when compared with the unvaccinated group (31.3% vs 52.6%). However, the rates of COVID-19–associated death were similar at 7.0% and 8.6% in vaccinated and unvaccinated patients, respectively. By univariate logistic regression, females, older patients, and individuals with higher modified Charlson Comorbidity Index scores were at a higher risk of death from COVID-19 infections. To account for the nonrandomized nature of COVID-19 vaccination status, a propensity score weighting approach was used. In the final propensity-weighted model, vaccination status was not significantly associated with the risk of death from COVID-19 infections but was associated with the risk of hospitalization. The predicted benefit of vaccination was an absolute decrease in the probability of death and hospitalization from COVID-19 infections by 2.3% and 22.9%, respectively. In conclusion, COVID-19 vaccination status in patients with hematologic malignancies was associated with a decreased risk of hospitalization but not associated with a decreased risk of death from COVID-19 infections in the pre-Omicron era. Protective strategies, in addition to immunization, are warranted in this vulnerable patient population.

Unplanned 30-day readmissions, comorbidity and impact on one-year mortality following incident heart failure hospitalisation in Western Australia, 2001–2015

BackgroundReadmissions within 30 days after heart failure (HF) hospitalisation is considered an important healthcare quality metric, but their impact on medium-term mortality is unclear within an Australian setting. We determined the frequency, risk predictors and relative mortality risk of 30-day unplanned readmission in patients following an incident HF hospitalisation.MethodsFrom the Western Australian Hospitalisation Morbidity Data Collection we identified patients aged 25–94 years with an incident (first-ever) HF hospitalisation as a principal diagnosis between 2001 and 2015, and who survived to 30-days post discharge. Unplanned 30-day readmissions were categorised by principal diagnosis. Logistic and Cox regression analysis determined the independent predictors of unplanned readmissions in 30-day survivors and the multivariable-adjusted hazard ratio (HR) of readmission on mortality within the subsequent year.ResultsThe cohort comprised 18,241 patients, mean age 74.3 ± 13.6 (SD) years, 53.5% males, and one-third had a modified Charlson Comorbidity Index score of ≥ 3. Among 30-day survivors, 15.5% experienced one or more unplanned 30-day readmission, of which 53.9% were due to cardiovascular causes; predominantly HF (31.4%). The unadjusted 1-year mortality was 15.9%, and the adjusted mortality HR in patients with 1 and ≥ 2 cardiovascular or non-cardiovascular readmissions (versus none) was 1.96 (95% confidence interval (CI) 1.80–2.14) and 3.04 (95% CI, 2.51–3.68) respectively. Coexistent comorbidities, including ischaemic heart disease/myocardial infarction, peripheral arterial disease, pneumonia, chronic kidney disease, and anaemia, were independent predictors of both 30-day unplanned readmission and 1-year mortality.ConclusionUnplanned 30-day readmissions and medium-term mortality remain high among patients who survived to 30 days after incident HF hospitalisation. Any cardiovascular or non-cardiovascular readmission was associated with a two to three-fold higher adjusted HR for death over the following year, and various coexistent comorbidities were important associates of readmission and mortality risk. Our findings support the need to optimize multidisciplinary HF and multimorbidity management to potentially reduce repeat hospitalisation and improve survival.

Efficacy of the Modified 5-Item Frailty Index in Predicting Surgical-Site Infections in Patients Undergoing Breast Implant Augmentation: A National Surgical Quality Improvement Project-Based 5-Year Study.

The ability to predict breast implant augmentation complications can significantly inform patient management. A frailty measure, such as the modified 5-item frailty index (mFI-5), is becoming an increasingly established risk factor for adverse postoperative outcomes. The authors hypothesized that the mFI-5 is predictive of 30-day postoperative complications in breast augmentation. To investigate if mFI-5 can predict the likelihood and magnitude of 30-day complications resulting from breast augmentations. A retrospective review study of the National Surgical Quality Improvement Program database for patients who underwent breast implant augmentation without other concurrent procedures, from 2015 to 2019. Age, BMI, number of major comorbidities, American Society of Anesthesiologists (ASA) classifications, smoking status, mFI-5 score, and modified Charlson comorbidity index score were compared as predictors of all-cause 30-day complications and 30-day surgical-site complications using regression analyses. Overall, 2478 patients were analyzed, and among them, 53 patients developed complications (2.14%). mFI-5 score significantly predicted surgical-site infection (SSI) complications (odds ratio [OR] = 4.24, P = .026). Frail patients had a higher occurrence of SSIs than nonfrail patients (P = .049). Multivariable analyses showed ASA class predicted 30-day SSI complications (OR = 5.77, P = .027) and mFI-5 approached, but did not reach full significance in predicting overall 30-day complications (OR = 3.14, P = .085). To date, the impact of frailty on breast implant procedure outcomes has not been studied. Our analysis demonstrates that the mFI-5 is a significant predictor for SSIs in breast implant augmentation surgery and is associated with overall complications. By preoperatively identifying frail patients, the surgical team can better account for postoperative support to minimize the risk of complications.

Chronic Disease and Other Determinants in Deaths Due to COVID-19 From a Health Protection and Promotion Perspective: A Retrospective Analysis.

To examine the age, gender, and chronic disease status of patients who died due to coronavirus disease 2019 (COVID-19) during the pandemic process and the effects of these diseases on their deaths. It was a retrospective retrospective analysis with 2715 patients. The statistics of the patients who met the research criteria were evaluated from the hospital database. Patients were evaluated in terms of age, gender, length of hospital stay, presence of chronic disease, and Modified Comorbidity Index Scores. It was determined that the Modified Charlson Comorbidity Index (MCCI) score mean of the patients was 4.74 ± 2.07 and MCCI scores of 56.9% were serious. There was a statistically significant difference in the length of hospital stay according to the number of diseases the patient had, age, and MCCI score. It was determined that there was a statistically significant, negative and high-level correlation between MCCI score and the length of hospital stay (r = -0.075: P = 0.001). Age, comorbidity score, and the number of comorbidities were found to affect the length of hospital stay, ie death. For this reason, it is recommended to use comorbidity indices in health protection and development studies, in the field, as well as in the clinics.

The Association Between Comorbidities and a High-Risk Status According to COPD GOLD Groups

Objective: The natural course of the chronic obstructive pulmonary disease (COPD) is thought to be affected by the severity of COPD, frequency of episodes, as well as the presence of comorbid conditions. It was aimed to explore the effect of comorbid conditions on high-risk status in stable COPD patients. Material and methods: Study participants consisted of stable COPD patients attending to the pulmonology outpatient unit of a tertiary center between 15th May 2018 and 12th Dec 2019. Demographic data, comorbidities, clinical index scores, modified Charlson comorbidity index score (mCCI), BODE index score, and the Short Form 36 (SF-36) scores as a generic life quality measure were recorded. Global Initiative for Chronic Obstructive Lung Disease (GOLD) groups were determined based on symptoms and exacerbations. Results: There were 23(25.8%), 31(34.8%), 2(2.2%), and 33(37.1%) patients in GOLD gropus A, B, C, and D, respectively. Among these, A and B groups are considered as low-risk, and C and D groups are considered as high-risk. High risk patients had higher mCCI (p < 0.001) and were more likely to have hypertension (p=0.012), congestive cardiac failure (p=0.029), chronic renal failure (p=0.022), osteoporosis (p=0.001), and anemia (p<0.001). In a logistic regression analysis performed to examine the determinants of high-risk status in COPD-GOLD groups, biomass exposure was found to increase the likelihood of having a high risk-status by 3-fold. Conclusion: Classification of stable COPD patients according to GOLD groups showed higher mCCI in subjects with high-risk status. Comorbidities and mCCI did not appear to affect the high-risk status. Biomass exposure was associated with an increased risk of having a high-risk status.

908. Impact of Antimicrobial Stewardship Protocol Mandating Infectious Diseases Consultation Post 72 Hours of Meropenem Usage

Abstract Background Carbapenem use correlates with the development of carbapenem-resistant organisms, prompting our antimicrobial stewardship program (ASP) to develop a policy mandating infectious diseases (ID) consultation after 72 hours of meropenem use. Our objective was to evaluate the impact of this policy on meropenem utilization and associated clinical outcomes. Methods This quasi-experimental, observational study evaluated the impact of the new ASP policy in adult patients across four campuses. Administered meropenem orders were retrieved retrospectively six months before (11/2020-4/2021) and after (6/2021-11/2021) policy implementation. The primary outcome was meropenem days of therapy per 1000 patient-days (DOTs). Secondary outcomes included DOTs of select broad-spectrum antimicrobials, 30-day all-cause mortality, hospital length of stay (LOS), and Clostridioides difficile (C. difficile) infection incidence. All outcomes were assessed in pre- and post-intervention periods. Results There were 1493 and 1404 meropenem orders in the pre- and post-intervention periods, respectively. Pre-intervention group patients had slightly higher modified Charlson Comorbidity Index scores (2.1 vs 1.9, p=0.02). Pre-intervention group had more patients with penicillin allergies but less patients with sulfa allergies (p=0.007 and p=0.03, respectively). The most common meropenem indications were bloodstream, respiratory, abdominal, and urinary tract infections. The incidence of extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales and cefepime-resistant Pseudomonas spp. was similar in both groups (p=0.7 and p=0.1, respectively). ID consultation increased after policy implementation (44.1% vs 51.7%, p=0.001). Meropenem DOTs decreased significantly after intervention (50.3 vs 35.5, p=0.0003). We observed increases in ceftriaxone and cefepime DOTs (94 vs 103.8, p=0.006 and 39 vs 58.5, p=0.0005, respectively). An increase in C. difficile incidence was seen. Hospital LOS was similar pre- and post-intervention (mean 18.5 days, p=0.9). Conclusion The ASP policy mandating ID consultation after 72 hours of meropenem use helped decrease meropenem DOT and encouraged use of antimicrobial agents with narrower spectrum. Disclosures All Authors: No reported disclosures.

Implementation of a Physical Activity Vital Sign in Primary Care: Associations Between Physical Activity, Demographic Characteristics, and Chronic Disease Burden.

Physical activity is important to prevent and manage multiple chronic medical conditions. The objective of this study was to describe the implementation of a physical activity vital sign (PAVS) in a primary care setting and examine the association between physical activity with demographic characteristics and chronic disease burden. We extracted data from the electronic medical records of patients who had visits from July 2018 through January 2020 in a primary care clinic in which PAVS was implemented as part of the intake process. Data collected included self-reported physical activity, age, sex, body mass index, race, ethnicity, and a modified Charlson Comorbidity Index score indicating chronic disease burden. We classified PAVS into 3 categories of time spent in moderate to strenuous intensity physical activity: consistently inactive (0 min/wk), inconsistently active (<150 min/wk), and consistently active (≥150 min/wk). We used χ2 tests of independence to test for association between PAVS categories and all other variables. During the study period, 13,704 visits, corresponding to 8,741 unique adult patients, had PAVS recorded. Overall, 18.1% of patients reported being consistently inactive, 48.3% inconsistently active, and 33.7% consistently active. All assessed demographic and clinical covariates were associated with PAVS classification (all P < .001). Larger percentages of consistent inactivity were reported for female, older, and underweight or obese patients. Larger percentages of consistent activity were reported for male, younger, and normal weight or overweight patients. Using PAVS as a screening tool in primary care enables physicians to understand the physical activity status of their patients and can be useful in identifying inactive patients who may benefit from physical activity counseling.

High Blood Cu/Zn Ratio is Associated with Nutritional Risk in Patients Undergoing Maintenance Hemodialysis.

Patients undergoing maintenance hemodialysis (MHD) are at risk of an imbalance of copper and zinc homeostasis. We hypothesized that there is an association between the blood copper-zinc (Cu/Zn) ratio and nutritional status in these patients. For this cross-sectional study, blood samples were collected from patients undergoing MHD at Guangzhou Red Cross Hospital in September 2019. Zinc and copper levels were measured using inductively coupled plasma mass spectrometry. The seven-point subjective global assessment (SGA), nutritional risk screening 2002 (NRS2002), and geriatric nutritional risk index (GNRI) were used to evaluate the overall nutritional status. We enrolled 144 MHD patients (men:women = 78:66), with an average age of 64.33 ± 13.39years and a median dialysis vintage of 33.50 (16.25-57.50) months. Patients with a higher blood Cu/Zn ratio had lower levels of hemoglobin, blood zinc, serum prealbumin, albumin, and creatinine as well as low SGA and GNRI scores, but higher modified Charlson comorbidity index score, serum C-reactive protein level, interleukin-6 level, blood copper level, and NRS2002 score (all p < 0.05). After adjustment for confounding factors in multivariable models, a high blood Cu/Zn ratio was independently associated with nutritional risk defined by all nutritional parameters (SGA, NRS2002, and GNRI). Prospective studies with larger sample sizes are warranted to confirm these results.

The Utilization and Safety of Same-Day Discharge After Transurethral Benign Prostatic Hyperplasia Surgery: A Case-Control, Matched Analysis of a National Cohort

ObjectiveTo analyze the utilization and safety of same-day (SDD) vs standard-length discharge (SLD) for transurethral resection (TURP), holmium laser enucleation (HoLEP), and GreenLight photovaporization (GL-PVP) of the prostate. MethodsUsing the 2015-2019 ACS-NSQIP files, the annual proportion of TURP, HoLEP, and GL-PVP performed with SDD (length of stay [LOS] = 0 days) was calculated. Patients were stratified by LOS into SDD and SLD (TURP: LOS = 1-3 days, HoLEP and GL-PVP: LOS = 1-2 days); those with longer LOS were excluded. Patients were matched 1:1 by age, body mass index, American Society of Anesthesiologists score, and modified Charlson Comorbidity Index score. We compared 30-day unplanned readmissions, reoperations, and Clavien-Dindo (CD) complications between SLD and SDD, and evaluated predictors of adverse outcomes using logistic regression. ResultsMost GL-PVP patients underwent SDD, compared to a minority of TURP and HoLEP patients. SDD utilization increased, remained stable, and decreased over time for HoLEP, TURP, and GL-PVP, respectively. For 46,898 included cases (31,872 TURP, 2,901 HoLEP, 12,125 GL-PVP), rates of reoperation, CD I/II, or CD IV complications were comparable before and after matching. Compared to SLD, 30-day unplanned readmission rates for matched SDD patients were lower following TURP (3.48% vs 4.25%, P = .013) and HoLEP (1.93% vs 4.43%, P = .003). On multivariate regression, SLD correlated with unplanned readmission after TURP and HoLEP for both unmatched and matched cohorts. ConclusionFor appropriately selected patients, SDD after TURP, HoLEP, and GL-PVP did not confer increased risk of 30-day complications, suggesting patient selection for SDD is being done with appropriate safety nationally.

Factors Affecting the Choice of Renal Replacement Therapy in Patients with End Stage Renal Failure

It was aimed to investigate the factors affecting the choice of renal replacement therapy by examining the data of patients with end stage renal disease, to whom we applied a predialysis education program. Patients who were started on renal replacement therapy in our clinic were evaluated retrospectively. Renal replacement therapy were divided into three groups as hemodialysis, peritoneal dialysis and renal transplantation and compared according to their clinical and demographic characteristics. The comorbidities of the patients were calculated using the 'modified charlson comorbidity index' score. There were a total of 464 patients in the study, of whom 330 (71.1%) chose hemodialysis, 65 (14%) peritoneal dialysis, and 69 (14.9%) renal transplantation. Age was significantly different between the groups (p<0.001). According to the hemodialysis patients of renal transplantation patients; that the rate of being a university graduate (p<0.001) and never married (p=0.004) is higher. Rate of living in the urban area (p=0.021) and working patients (p=0.031) were higher in renal transplantation patients. The rate of diabetic nephropathy of renal etiology was lower in renal transplantation patients (p=0.014). When the modified charlson comorbidity index scores of the groups were examined, highest values were in the hemodialysis group and the lowest values were in the transplantation group (p<0.001). Patients sociodemographic characteristics and comorbid conditions were effective in the choice of renal replacement therapy modality. In addition to the educating given before the selection, most appropriate treatment modality should be selected by considering these features.

EVALUATION OF FACTORS AFFECTING MORTALITY IN GERIATRIC HIP FRACTURE SURGERY: A RETROSPECTIVE STUDY

Introduction: The primary aim of this study is to evaluate the effect of anesthesia methods on in-hospital, 30-day, and six-month mortality following geriatric hip fracture surgery. The secondary aim is to evaluate the effect of preoperative comorbidities on mortality. Method: This retrospective study included patients aged ≥75 years who had undergone femoral neck fracture surgery. Results: The data of 135 patients were analyzed. The postoperative stay in the intensive care unit of patients who were given general anesthesia (p &lt; 0.05) was significantly longer. In the comparisons made according to survival, the exitus cases were found to have higher rates of renal disease and dementia. The variables found to be significantly different in the paired comparisons and determined to be a risk factor as a result of logistic regression analysis were applied with an receiver operating characteristic analysis, as a result of which a cutoff value of 6 in the modified Charlson comorbidity index score was found to be statistically significant area under curve = 0.727, p &lt; 0.001, 95% CI: 0.644–0.800). The cutoff value for preoperative hemoglobin was determined to be 11.4 (Area under curve = 0.643, p = 0.005, 95% confidence interval: 0.556– 0.723). Conclusions: Ensuring the preoperative waiting time does not exceed 48 hours, optimizing the medical and hemodynamic status with a multidisciplinary approach, and determining the anesthesia method according to the clinical characteristics of each patient may contribute to reducing mortality rates. Keywords: Hip Fractures; Geriatrics; Anesthesia; Mortality.

Modified Charlson comorbidity index as a pre-operative selection tool for liver transplantation in elderly patients

Liver transplantation is an effective treatment for end-stage liver disease and hepatocellular carcinoma. The number of elderly patients who undergo liver transplantation is increasing. Although it has been known that the overall outcome in elderly patients is no different from the younger ones, there is no tool to predict the prognosis of elderly patients. Therefore, we hypothesized that modified Charlson comorbidity index (CCI), which includes 5 comorbidities, can predict the outcome of elderly patients. We conducted a retrospective study of 155 patients over 65 years old who underwent liver transplantation at Seoul National University Hospital from August 2011 to May 2019. Modified CCI score (MODIFIED CCI) including coronary disease, Chronic Obstructive Pulmonary Disease, Diabetes Mellitus, connective tissue disease, and renal insufficiency was calculated. Then, recipients were subcategorized into 2 groups; low MODIFIED CCI group (0-1), and high MODIFIED CCI group (2-5). Proportional hazards analysis was performed to determine the independent effect of each variable on post-transplantation survival using MODIFIED CCI, age at transplantation, gender, Child-Turcotte-Pugh score, Model for End-Stage Liver Disease (MELD) score, and 5-Factor Modified Frailty Index. There were 41 patients in the high MODIFIED CCI group. The high MODIFIED CCI group showed significantly lower 1-, 3- month, and 1, 3, 5-year survival than the low MODIFIED CCI group. In the Cox regression, the MODIFIED CCI (HR = 2.409), gender (HR = 0.447), and MELD score (HR = 1.107) remained. Survival after LT is diminished in patients with preoperative high MELD and MODIFIED CCI score >1. The MODIFIED CCI can be used.

Opioid prescribing and health outcomes in opioid-naive patients: Analysis of a statewide health information exchange

BackgroundWidespread use of prescription opioids is associated with adverse outcomes. ObjectiveTo identify factors associated with adverse health outcomes and health care use using a statewide health information exchange. MethodsThis is a retrospective cohort study using the Indiana Network for Patient Care. Adult opioid-naive patients who received an opioid prescription between January 2012 and December 2017 were included. The outcomes included (1) a composite outcome of any combination of opioid abuse, dependence, or overdose, (2) all-cause mortality, and (3) health care use. Independent variables included opioid dosage, dispensed amount, days supply, concurrent use of short-acting (SA) and long-acting (LA) opioids, and concurrent use with benzodiazepine or gabapentinoids. Additional variables included patients’ age, sex, race, modified Charlson Comorbidity Index score, mental health conditions, and medications for opioid use disorders. Factors associated with composite outcome and mortality were identified using Cox proportional hazards and reported as adjusted hazard ratio (aHR) and 95% CI. Factors associated with health care use were identified using Poisson regression and reported as adjusted incidence rate ratio (aIRR) and 95% CI. Results1,328,287 opioid prescriptions were identified for 341,722 patients. Opioid-related factors associated with the composite outcome, mortality, and hospitalizations, respectively, included opioid dosage (aHR 1.003 [95% CI 1.001–1.006]; aHR not applicable; aIRR 1.07 [1.06–1.08]), opioid days supply (aHR 1.03 [1.02–1.03]; aHR 1.009 [1.005–1.014]; aIRR 0.94 [0.92–0.96]), concurrent SA/LA opioids (aHR 2.12 [1.78–2.54]; aHR 1.40 [1.14–1.70]; aIRR 1.40 [1.37–1.42]), and use of benzodiazepines/gabapentinoids (aHR 1.68 [1.38–2.04]; aHR 1.23 [1.01–1.51]; aIRR 1.25 [1.23–1.27]). ConclusionMany factors are associated with poor health outcomes, especially concurrent use of SA and LA opioids and overlapping prescriptions of opioids with benzodiazepines or gabapentinoids. Identification of factors associated with adverse outcomes may help identify patients at risk for poor outcomes and could inform possible interventions.

Real-World Treatment Patterns, Healthcare Resource Utilization and Associated Costs Among Patients with Chronic Myeloid Leukemia in Later Lines of Therapy

Real-World Treatment Patterns, Healthcare Resource Utilization and Associated Costs Among Patients with Chronic Myeloid Leukemia in Later Lines of Therapy

P0784RAPID WEIGHT CHANGE OVER TIME IS A RISK FACTOR FOR ADVERSE OUTCOMES IN PREDIALYSIS CHRONIC KIDNEY DISEASE: RESULTS FORM KNOW-CKD STUDY

Abstract Background and Aims Both obesity and underweight are related to the adverse outcomes in the chronic kidney disease (CKD). However, the effects of longitudinal weight changes on predialysis CKD population has not been studies so far. In this study, we analysed the effects of longitudinal body weight changes on the adverse outcomes in the predialysis CKD population, using the multicentre prospective cohort study in Korean pre-dialysis CKD cohort, so called KNOW-CKD. Method In this longitudinal analysis, total 2,022 patients were included. Longitudinal weight changes of study population were calculated into the percent change per year using regression analysis and classified into five groups: group 1; ≤ -5%/year (74 subjects), group 2; -5&amp;lt; to ≤-2.5 %/year (122 subjects), group 3; -2.5&amp;lt; to &amp;lt;2.5%/year (1642 subjects), group 4; 2.5≤ &amp;lt;5 %/year (123 subjects), and group 5; ≥ 5 %/year (61 subjects). The risk of end-stage renal disease (ESRD) development and composite outcome of cardiovascular disease (CVD) and all-cause death were compared according to the longitudinal weight changes. Results During the median 4.4 years of follow-up, total 414 and 188 events of ESRD and composite outcome of CVD and death occurred. When cause-specific regression analysis was conducted before and after adjusting age, sex, body mass index, mean blood pressure, estimated glomerular filtration rate, urine albumin-to-creatinine ratio, diabetics, cardiovascular disease, and modified Charlson Comorbidity Index score, all groups showed significant increased HR compared to group 3 for the ESRD. There was U-shape correlation between the degree of longitudinal body weight changes and the renal outcome (HR 3.89, 2.00, 1.89 and 3.34, P &amp;lt;0.001, &amp;lt;0.001, =0.001 and &amp;lt;0.001 for group 1, 2, 4 and 5, respectively). Also similar U-shape relationship was seen with composite outcome, (HR 3.14, 2.05, 1.65 and 2.68, P &amp;lt;0.001, 0.007, 0.123 and 0.007 for group 1, 2, 4 and 5, respectively) when compared to the reference group 3 When spline curve was drawn between the longitudinal body weight changes and adjusted HR for ESRD and composite of CVD and death, clear U-shape relationship was observed (Figure). The U-shape correlation was highlighted in the subgroup of estimated glomerular filtration rate &amp;lt;45 mL/min/1.73m2. Conclusion Both rapid weight reduction and gain are independent risk factor for the ESRD development and composite outcome of CVD and death in predialysis CKD patients, especially in advanced CKD stages. Therefore, monitoring bodyweight changes are important and more studies are needed to give safe guideline to the predialysis CKD for maintaining optimal nutritional status.

Association of medical comorbidities and cardiovascular disease with toxicity and survival in patients receiving checkpoint inhibitor immunotherapy.

7039 Background: Checkpoint inhibitor immunotherapy (IO) is widely used to treat advanced cancer in pts. with medical comorbidities (MC), but the effect of MC on outcomes is poorly understood. Methods: We performed a single institution retrospective cohort study of pts. who received IO from 2011-2018. Immune-related adverse events (irAEs) were graded by Common Terminology for Adverse Events criteria, v4.0. MC were abstracted by query of ICD-10 codes corresponding to diagnoses in the Charlson Comorbidity Index (CCI) at any time prior to IO start. Modified CCI scores excluding points for cancer were calculated for each pt. Bivariate analysis with chi-squared statistics was used to describe characteristics and MC of pts. with vs. without irAEs. Overall survival (OS) was estimated by the Kaplan-Meier method (from start of first-line IO) and compared using the log-rank test. The association of CCI score and individual MC with irAEs and OS was tested with regression models adjusted for pt. characteristics. Results: Among 671 pts. with advanced cancer (39.6% melanoma; 21.8% non-small cell lung) treated with IO, median age 65 (IQR 55-74) years, the most common MC were COPD (24%) and diabetes (20%). 33.8% of pts. had CCI score ≥2. Neither CCI score nor any specific MC were associated with any grade or ≥G3 irAEs (P &gt; 0.05). Increasing CCI score was significantly associated with decreased OS (P = 0.002). CHF (13.9 vs. 8.1 months, P = 0.008) and previous MI (14.2 vs. 10.1 months, P = 0.009) were associated with decreased median OS but did not remain significant in the regression model. Among pts. without cardiovascular disease (CVD), pts. with ≥G3 irAEs had longer OS than pts. with no ≥G3 irAEs (P &lt; 0.001). This OS benefit for ≥G3 irAEs was not seen in pts. with CVD (P = 0.94). See table for adjusted HR. Conclusions: Risk for irAEs does not appear to be impacted by MC. Pts. with MC have shorter OS, but no specific MC are associated with OS after adjustment for pt. characteristics. OS is significantly increased among pts. without CVD who experience ≥G3 irAEs. CVD may be an important predictor of OS in pts. with irAEs and should be evaluated in patients receiving IO. [Table: see text]

Preoperative Nutrition Consults Associated with Decreased Postoperative Complication Rate and Decreased Length of Hospital Stay After Spine Metastasis Surgery

Preoperative malnutrition is associated with increased postoperative complication rate and hospital length of stay. However, the degree to which these risks can be mitigated by nutritional consultation has not been well described. To address this, we sought to determine if a preoperative nutrition consult was associated with decreased 30-day complication rate and hospital length of stay. Adult patients who underwent neurosurgical intervention for spinal metastases at a tertiary care institution between 2008 and 2016 were retrospectively reviewed. Stepwise multivariable linear regression analyses were used to identify associations with 30-day complication rate and hospital length of stay. Among 95 patients who met inclusion criteria, the average length of stay was 8.9 days and 40 patients (42.1%) experienced one or more postoperative complications. On multivariable analysis, 30-day complication rates were higher in patients with the absence of a preoperative nutrition consult, a Modified Charlson Comorbidity Index score of greater than 2 points, greater operative blood loss, and malnutrition (Nutritional Risk Index score <97.5). Furthermore, hospitalization duration was increased with the absence of a nutrition consult, malnutrition, congestive heart failure, and prior systemic therapy in the multivariable analysis. On multivariable analysis, receipt of a preoperative nutrition consult was associated with both decreased 30-day complication rate and shorter hospitalization. We therefore posit that greater implementation of nutritional counseling may help to decrease complication rates and expedite discharge in patients undergoing surgical intervention for spinal metastases.

Similarities and differences in the correlates of comorbidities in US male and female adult cancer survivors.

To determine both the common and the sex-specific correlates of comorbidities in adult male and female cancer survivors. Cross-sectional study using the 2009-2014 National Health and Nutrition Examination Survey (NHANES). Male (n=667) and female (n=772) cancer survivors 20years of age and older. Questionnaire responses from NHANES provided data for this study. Comorbidities were assessed using a modified Charlson Comorbidity Index (CCI). Bivariate and multivariate linear regression analyses were conducted to identify correlates of comorbidities in male and female cancer survivors separately. The mean modified CCI score was 3.88 in males and 3.68 in females. Having a greater number of cancers diagnosed, being currently or formerly married, being physically inactive, having lower socioeconomic status, and being a former smoker were significant correlates of comorbidities in both males and females. Having a prostate cancer diagnosis was also a significant correlate of comorbidities in males. White race, more years since first cancer diagnosis, being overweight or obese, and having no more than a high school education were also significant correlates of comorbidities in females. There are differences between correlates of comorbidities in male and female cancer survivors.

Arterial and Venous Thromboembolic Safety of Bevacizumab in Patients with High Grade Gliomas

INTRODUCTIONBevacizumab, an angiogenesis inhibitor targeting vascular endothelial growth factor A, is used for the treatment of recurrent glioblastoma, the most common primary brain malignancy in adults. Multiple studies demonstrate the efficacy of bevacizumab on progression-free and overall survival of patients with recurrent glioblastoma. However, real world safety data of bevacizumab in patients with glioblastoma is limited on serious adverse outcomes including arterial and venous thrombosis. Our study aimed to evaluate the risk of arterial thromboembolism (ATE) and venous thromboembolism (VTE) in a population-based sample of adult patients with high grade gliomas.METHODWe conducted a nested case-control study within a retrospective cohort of patients receiving treatment for high grade gliomas under the protocol by Stupp, et al. (radiotherapy plus concomitant/adjuvant temezolomide). Patients were sampled from the Truven Health MarketScan® Research Database, containing administrative health claims data of over 40 million commercially insured enrollees and their dependents, between 2009 and 2015. A validated algorithm was used to identify patients with high grade gliomas that underwent craniotomy (index time) with external beam radiation and temozolomide-based treatment occurring within 91 days (cohort entry time). Patients were excluded if they received craniotomy, radiation, temozolomide or bevacizumab during year prior to surgery or had one of our outcomes of interest (ATE or VTE) during the cohort ascertainment period (between index and cohort entry dates). Patients were required to have continuous health plan enrollment during the 12-month baseline and follow up periods (unless died). Surgical procedures and chemotherapy treatments were identified using diagnostic and procedural medical and pharmacy claims data. These data sources were also used to identify VTE risk factors, including medical conditions, procedures and medication use, and to calculate modified Charlson comorbidity index scores at baseline.Cases of ATE and VTE were each identified in the overall cohort using a validated algorithm for administrative claims data. For ATE and VTE separately, each case was matched to up to ten controls on sex, age group, index time and follow-up duration using incidence density sampling with replacement. Exposure to bevacizumab was characterized as any use (yes vs. no) and recent use (last bevacizumab infusion within 30 days prior event or control censoring). We estimated relative risk of ATE and VTE associated with bevacizumab in separate models using conditional logistic regression models to calculate adjusted odds ratios (aOR) and 95% confidence interval (CI). All multivariable models were adjusted for sex, age, and comorbidity index scores; models for risk of VTE were also adjusted for number of baseline VTE risk factors and VTE prophylaxis received.RESULTSOur final study cohort included 2157 patients undergoing treatment for high grade gliomas. We identified 25 ATE cases and 99 VTE cases and matched incidence density-sampled controls (n=170 for ATE; n=819 for VTE) for our nested case-control analysis. A higher proportion of ATE cases received bevacizumab during follow up compared to the controls (28% vs. 17%). In multivariable analyses, no statistically significant increase in ATE risk was observed with bevacizumab overall (aOR 1.51, 95% CI 0.54-4.24), although confidence intervals were wide given the few events observed. Compared to controls in the VTE analysis, cases had a slightly higher proportion of baseline VTE risk factors (2 or more: 17% vs. 13%) and treatment with bevacizumab (13% vs. 9%). However, we found no significant increased risk of VTE associated with bevacizumab overall (aOR 1.40, 95% CI 0.71-2.75) or recent infusion of bevacizumab (aOR 1.40, 95% CI 0.65-3.01).CONCLUSIONSOur findings from this large retrospective cohort of patients undergoing treatment for high grade glioma provide little evidence in support of the increased risk of ATE and VTE reported with use of bevacizumab in other cancer sites. Our study was limited by an overall small number of ATE events observed, and further research is needed to confirm safety of bevacizumab with respect to arterial thrombosis. These population-based estimates show no significant increase in risk of VTE associated with bevacizumab and suggest its safe use in the treatment of high grade gliomas. DisclosuresLee:AbbVie Inc.: Research Funding. Patel:Celgene: Consultancy, Honoraria; Amgen: Consultancy, Honoraria; Janssen: Honoraria.

The relationship of Charlson comorbidity index with stent restenosis and extent of coronary artery disease

ObjectivesThe objective of this study is to investigate the effect of comorbid conditions [Charlson comorbidity index (CCI)] on stent restenosis who underwent coronary angioplasty earlier.MethodsPatients were divided into two groups; patients with critical restenosis [recurrent diameter stenosis >50% at the stent segment or its edges (5-mm segments adjacent to the stent) (Group 1; n = 53, mean age: 63.8 ± 9.9 years)] and patients with no critical restenosis [<50% obstruction (Group 2; n = 94, mean age: 62.1 ± 9.1 years)]. The CCI and modified CCI were used for the presence of comorbid conditions. The Gensini scoring system was used to assess the extent of coronary artery disease (CAD).ResultsGroup 1 had a significantly greater CCI and modified CCI score compared to Group 2 (7.1 ± 3.7 vs. 5.6 ± 1.6, p = 0.006; 6.9 ± 3.6 vs. 4.5 ± 1.5, p = 0.008, respectively). There was a weak correlation, albeit significant, between the modified CCI score and restenosis percentage (r = 0.29, p < 0.001; r = 0.25, p = 0.003, respectively).ConclusionsIn conclusion, the CCI score is greater among patients with stent restenosis than those without. CCI score is higher among patients with a more diffuse CAD than with a milder disease extent.