Possible Predictors Of Recurrence Research Articles

Preoperative systemic inflammatory markers as prognostic factors in differentiated thyroid cancer: a systematic review and meta-analysis.

Inflammation has been associated with tumor development and circulating inflammatory biomarkers have been proposed as possible predictors of recurrence of several solid tumors. However, the role of inflammation markers in differentiated thyroid carcinoma (DTC) is still uncertain. This meta-analysis aimed to assess the prognostic value of neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) in patients with DTC. Studies investigating the association between survival and preoperative circulating inflammatory markers in DTC patients were included. The primary outcome was disease-free survival (DFS). Cumulative logarithms of the hazard ratio (log-HRs) with 95% CI were calculated through the inverse variance method using a random-effects model. A total of 7599 patients with a mean age of 48.89 (95% CI 44.16-53.63) were included. The estimated pooled log-HRs for DFS were 0.07 for NLR (95% CI -0.12-0.26; p = 0.43), -0.58 for LMR (95% CI -1.21-0.05; p = 0.06), and 0.01 (95% CI 0-0.01; p = 0.21) for PLR. Our meta-analysis showed no association between NLR, PLR, LMR and DFS in DTC; however, more prospective data are needed to better define the association between inflammatory status and prognosis of DTC.

Collagen Family Genes Associated with Risk of Recurrence after Radiation Therapy for Vestibular Schwannoma and Pan-Cancer Analysis.

Background The safety of radiotherapy techniques in the treatment of vestibular schwannoma (VS) shows a high rate of tumor control with few side effects. Neuropeptide Y (NPY) may have a potential relevance to the recurrence of VS. Further research is still needed on the key genes that determine the sensitivity of VS to radiation therapy. Materials and Methods Transcriptional microarray data and clinical information data from VS patients were downloaded from GSE141801, and vascular-related genes associated with recurrence after radiation therapy for VS were obtained by combining information from MSigDB. Logistics regression was applied to construct a column line graph prediction model for recurrence status after radiation therapy. Pan-cancer analysis was also performed to investigate the cooccurrence of these genes in tumorigenesis. Results We identified eight VS recurrence-related genes from the GSE141801 dataset. All of these genes were highly expressed in the VS recurrence samples. Four collagen family genes (COL5A1, COL3A1, COL4A1, and COL15A1) were further screened, and a model was constructed to predict the risk of recurrence of VS. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses revealed that these four collagen family genes play important roles in a variety of biological functions and cellular pathways. Pan-cancer analysis further revealed that the expression of these genes was significantly heterogeneous across immune phenotypes and significantly associated with immune infiltration. Finally, Neuropeptide Y (NPY) was found to be significantly and negatively correlated with the expression of COL5A1, COL3A1, and COL4A1. Conclusions Four collagen family genes have been identified as possible predictors of recurrence after radiation therapy for VS. Pan-cancer analysis reveals potential associations between the pathogenesis of VS and other tumorigenic factors. The relevance of NPY to VS was also revealed for the first time.

Long term prognosis of out-of-hospital cardiac arrest due to idiopathic ventricular fibrillation - a tertiary center experience

Abstract Funding Acknowledgements Type of funding sources: None. Background Sudden cardiac death (SCD) is an uncommon event in the absence of structural heart disease. However, ventricular fibrillation (VF) may occur in patients with unknown cardiac disease and a comprehensive work-up is needed to further improve diagnostic. Still, a significant and heterogenous group of patients remains labelled of Idiopathic VF and limited data is available regarding their natural history. Purpose The aim of this study was to evaluate the clinical outcomes of survivors of an aborted sudden cardiac death due to idiopathic VF or pulseless ventricular tachycardia (VT) and to assess possible predictors of recurrence. Methods Patients who survived an idiopathic VF or pulseless VT between 2005 and 2019 referred to a cardiac defibrillator (ICD) implantation were included. Patients were followed for 1 to 15 years (median follow-up of 7 years). Clinical and device data were collected. Results A population of 29 patients, 59% male, with a median age of 50 years (age ranging from 18 to 76) at the time of the aborted SCD was studied. All patients implanted an ICD (69% single chamber, 24% dual chamber and 3% subcutaneous) at the index hospitalization. The initial rhythm was VF in 76% and pulseless VT in 24%. In relation to the context of the arrhythmic event, 48.3% occurred during daily life activities, 13.8% after an emotional stress, 6.9% during efforts and a similar percentage occurred either in rest or asleep. Of note, 12.5% of patients had previous history of syncope. Normal ECG was present in 83% of patients. Family history of SCD was present in 12% of the cases. As for the cardiovascular risk factors, 61.5% had hypertension, 19% dyslipidemia, 17% diabetes, 31% were smokers or previous smokers. Paroxysmal atrial fibrillation was present in 15% of patients. To exclude possible causes of VF, all patients were submitted to coronary angiogram and echocardiogram, 64% to genetic testing, 68% to cardiac magnetic resonance, 20% to electrophysiologic study, 12% to pharmacological provocative test and 4% were submitted to endomyocardial biopsy. At follow-up, an etiological diagnosis was established in 31% of patients: 3 events were attributed to coronary vasospasm, 3 to short coupled polymorphic VT, 1 patient had long QT syndrome, 1 had Brugada syndrome and in 1 patient an ANK2 mutation was identified. As for the clinical outcomes, 8% patients died (from non-arrhythmic causes), 31% patients received appropriate therapies and 19% had unappropriated shocks (of those 60% for sinus tachycardia and 40% for supraventricular tachycardia). Conclusion Etiologic diagnosis and prediction of recurrence of arrhythmic events in patients with idiopathic VF is challenging, even with a long-term follow-up and more sophisticated diagnostic evaluation. Idiopathic VF is a rare but serious condition with recurrence in about one third of patients. Although not free of complications, ICD remains the gold standard of treatment.

Predictors of AVNRT Recurrence After Slow Pathway Modification.

Atrioventricular nodal reentry tachycardia (AVNRT) is the most common regular supraventricular tachycardia (SVT). Slow pathway modification (SPM) is the accepted first line treatment with reported success rates around 95%. Information regarding possible predictors of AVNRT recurrence is scarce.Out of 4170 consecutive patients with SPM in our department from 1993-2018, we identified 78 patients (1.9%) receiving > 1 SPM (69% female, median age 50 years) with a recurrence of AVNRT after a successful SPM. We matched these patients for age, gender and number of radiofrequency applications during first SPM with 78 patients who received one successful SPM in our center without AVNRT recurrence. Both groups were analyzed for possible predictors of a recurrence of AVNRT during long-term follow-up. The recurrence group contained a significantly lower proportion of patients with an occurrence of junctional beats during SPM (69% versus 89%, P = 0.006). Moreover, significantly more cases of previously diagnosed atrial fibrillation/tachycardia (AF/AT; 21% versus 5%, P = 0.007) and inducible AF/AT during electrophysiology study (23% versus 6%, P = 0.006) were present in the recurrence group. While more than half of patients had a recurrence within the first year, in 20% symptoms reappeared ≥ 4 years after ablation.In a small percentage of patients, AVNRT recurs after an initially successful ablation. Interestingly, these patients had significantly fewer junctional beats during ablation and a higher rate of other (inducible) arrhythmias. AVNRT recurrence spanned a considerable timeframe and should remain a differential diagnosis, even years after ablation.

Analysis of risk factors predicting recurrence of chronic subdural hematoma

Recurrences after evacuation of chronic subdural hematoma are seen in 2-33% of cases with various surgical approaches. Various demographical, clinical, radiological, surgical and postoperative management strategies have been explored as the possible predictors of recurrence.
 We performed a retrospective analysis in 160 patients with chronic subdural hematoma with an aim to analyze the post-operative recurrences and factors associated with it. Various socio demographic and clinico-radiological parameters were studied against the rate of recurrence after surgery using Chi square/Fischer Exact Test. Factors showing significant association on univarate analysis were then analysed using binary logistic regression.
 The rate of recurrence of CSDH in our study was 5% and the mean duration of recurrence was 33 days. Chronic alcohol use (p=0.007) and intraoperative brain expansion ((p=0.001) were the two factors associated with recurrence of CSDH. On binary logistic regression chronic alcohol use (wald-6.467, p=0.011) and intraoperative brain expansion (wald=6.674, p=0.010) were both associated significantly with recurrence of CSDGH with an odds of 7.804 and 0.058 respectively.

Histology, Tumor Volume, and Radiation Dose Predict Outcomes in Non-Small Cell Lung Cancer Patients after Stereotactic Ablative Radiation Therapy

Histology, tumor volume, and radiation dose have been separately reported as possible predictors of recurrence in non-small cell lung cancer following stereotactic ablative body radiotherapy (SABR). However, it remains unclear if histology should be independently considered when choosing SABR dose prescriptions. The study population included 508 patients with 561 lesions treated between 2000 and 2016, of which 442 patients with 482 lesions had complete dosimetric information. The primary endpoint was in-field tumor control censored by either death or progression. Involved lobe control was also assessed. At a median follow-up of 6.7 years, 3-year in-field control, involved lobe control, overall survival, and progression-free survival were 88.1%, 80.0%, 49.4%, and 37.2%, respectively. Gross tumor volume (GTV, HR=1.01 per mL, p=0.0044) and histology (p=0.0225) were independently associated with involved lobe failure; GTV (HR=1.013, p=0.001) and radiation dose to the GTV (cutoff of 110Gy, biologically effective dose with α/β=10 [BED10], HR=2.380, p=0.0084) were independently associated with in-field failure. For squamous cell carcinomas, lower prescription doses were associated with worse in-field control independent of GTV (≤ vs. >110Gy BED10: HR=3.621, p=0.0147; 12Gyx4 or 10Gyx5 vs. 18Gy or 20Gyx3: HR=3.530, p=0.0447). For adenocarcinomas, there were no differences in in-field control observed using the above dose groupings (p=0.12 and p=0.31). GTV, dose to GTV, and histology are important factors contributing to involved lobe and in-field recurrence risk. A dose local control relationship was observed for squamous cell carcinomas treated with commonly used SABR dose prescriptions. In the absence of level I data to guide management, we posit that GTV and histology should be considered to personalize radiation dose for SABR. We suggest lower prescription doses (i.e., 12Gyx4 or 10Gx5) should be avoided for squamous cell carcinomas if there are no concerns about normal tissue toxicity.

Disease Free Survival of Well Differentiated Thyroid Cancer: 20 years Experience at a tertiary care center in Lebanon

Background: Thyroid cancer is the most common endocrine malignancy. Although relatively common, to date, there is no study about its prognosis in Lebanon. The objectives of this study were to determine the disease free survival, the recurrence rate and possible predictors of recurrence, as well as the rate of post thyroidectomy complications among patients with differentiated thyroid cancer who received treatment at the American University of Beirut Medical Center.
 Methods and Findings: retrospective observational study of 480 cases of differentiated thyroid cancer who underwent thyroidectomy between January 1995 and June 2014. The mean age was 42±14 years. 74.4% were females. The mean tumor size was 1.9 cm±1.4. Papillary type was predominant (91%). Males had more extra-glandular extension than females (24.8% versus 10.9% respectively, p=0.001), more lymph node involvement (69.7% versus 52.9% respectively, p=0.017) and more vascular invasion (28.1% versus 14.9%, p=0.007). Around 70% of patients had at least one follow up visit after the surgery; among those, the median follow up duration was 4 years (1month-19years). At last follow-up visit, 78.7% were disease free, 14.9% had residual disease and only 6.3% had recurrent disease. By multivariate analysis, age greater than 45 years was the only independent predictor of persistence or recurrence (p=0.03) whereas both age below 45 years and lack of vascular invasion were significant predictors of disease free survival (p=0.001 and p=0.019 respectively).
 Conclusion: Differentiated thyroid cancer has an overall good prognosis in this cohort of Lebanese patients. Young age and lack of vascular invasion are the most important predictors of disease free survival.
 
 Key words: Differentiated thyroid cancer: disease free survival, prognostic factors, recurrence

Factors influencing the recurrence rate of operated chronic subdural hematomas

AbstractIn this study we are trying to establish a correlation between the surgical technique used for the treatment of chronic subdural hematomas and the risk of recurrence. Between 01.06.2008 and 31.05.2014, 123 patients with 138 chronic subdural hematomas (CSDH) were operated on and followed-up in our department. Among them, 16 hematomas (11,6%) recurred. Factors related to the patients (gender, age, location of the hematoma) are analyzed as possible predictors of recurrence. Several surgical techniques were used in the treatment of chronic subdural hematomas. Each of them is analyzed to find possibly connections with the recurrence risk of the size of the approach, the reposition of the bone flap, the suture of the dura and other aspects. There are obvious, statistically significant correlations between the risk of recurrence and some elements of the surgical technique employed.

OPTIMIZATION OF PATIENTS’ SELECTION FOR INTERVENTIONAL TREATMENT OF ATRIAL FIBRILLATION AND PREDICTORS OF ITS RECURRENCE AFTER CATHETER ABLATION

We analyzed possible predictors of recurrence of atrial fibrillation after catheter ablation with the subsequent formation of a mathematical model predicting the efficacy of interventional treatment. This approach makes it possible to optimize the selection of patients with atrial fibrillation for radiofrequency ablation and increase its effectiveness.

Long-term results of nonoperative treatment for uncomplicated acute appendicitis.

This study aimed to assess the long-term (>12 months) efficacy of nonoperative treatment (antibiotic administration) in the management of uncomplicated acute appendicitis (AA). We surveyed uncomplicated AA patients who elected to undergo nonoperative treatment between 2010 and 2012. A binary logistic regression analysis was performed to identify the critical predictors of recurrence. Age, gender, presence of appendicolith, and white blood cell count on admission were analyzed as possible predictors of recurrence. The median follow-up period of the study was 23 months. Twelve of 118 patients (10.2%) were diagnosed with recurrent appendicitis. Seven were retreated with the same antibiotic protocol and did not show further recurrence. The binary logistic regression analysis revealed statistical significance only for the presence of appendicolith [P=0.001, Exp (B)=0.058, B=-2.845]. Recurrence rate was lower in the presence of appendicolith. Nonoperative treatment of uncomplicated AA is an effective option. Recurrence is rare and it can be addressed efficiently with the administration of a second course of antibiotics. The presence of appendicolith should not discourage physicians from prescribing nonoperative treatment for patients with uncomplicated AA.

Management of atypical cranial meningiomas, part 1: predictors of recurrence and the role of adjuvant radiation after gross total resection.

Indications for external beam radiation therapy (EBRT) for atypical meningiomas (AMs) remain unclear. To analyze features associated with recurrence in AM patients after gross total resection (GTR) and to assess the relative benefit of EBRT in a retrospective cohort study. One hundred fifty-one primary AMs after GTR (88 female patients; median follow-up, 45.0 months) were examined for possible predictors of recurrence (age, sex, location, volume, bone involvement, brain invasion). The Fisher exact and Wilcoxon rank-sum tests were used to analyze the association between these predictors and use of EBRT. The impact on recurrence for these predictors and EBRT was analyzed with Kaplan-Meier and Cox regression. Of 151 patients, 13 (8.6%) experienced recurrence after GTR (median, 47.0 months). Multivariate analysis identified elevated mitotic index (P = .007) and brain invasion (P = .002) as predictors of recurrence. Larger volume (P = .96) was not associated with recurrence but was more likely to prompt EBRT (P = .001). Recurrences occurred in 11 of 112 with GTR (9.8%; median, 44 months) and 2 of 39 with GTR/EBRT (5.1%; median, 133 months). The 2-, 5-, and 10-year progression-free survival rates after GTR vs GTR/EBRT were 97%, 86%, and 68% vs 100%, 100%, and 78%. Kaplan-Meier analysis demonstrated no difference in progression-free survival or overall survival after GTR vs GTR/EBRT (P = .8, P > .99). Brain invasion and high mitotic rates may predict recurrence. After GTR of AMs, EBRT appears not to affect progression-free survival and overall survival, suggesting that observation rather than EBRT may be indicated after GTR.

Long-term results of treatment of acute diverticulitis: still lessons to be learned?

The aim of the present study was to evaluate the long-term results in patients treated for diverticular disease (DD), mainly considering indication for surgery, outcome of the treatment modalities and quality of life. All consecutive patients who underwent treatment for diverticular disease since January 2003 to June 2007 were analyzed. Patients were divided into three groups: medical treatment, elective surgery and emergency surgery. The patients responded to the questions of the Cleveland Global Quality of Life (CGQL) questionnaire and to a symptoms questionnaire during a telephone interview. The long-term outcome parameters such as readmission to the hospital, further surgery for DD, current health status, and quality of life were analyzed according to possible predictors. 146 patients (72.2 %) agreed to submit to the telephone interview and were enrolled in the study. The median follow-up was 99 months. Fifty-two patients were managed with medical therapy, 36 patients received elective operations, and 58 patients underwent acute surgery. Twelve patients (12.7 %) complained episodes of persistent abdominal pain after surgical resection, compared with 6 non-surgical patients (11.5 %). No possible predictors of recurrence, reoperation or readmission were found. The CGQL total scores were found to be similar in the three groups. DD affected bowel function and quality of life of patients in the long-term follow-up regardless of the type of therapy adopted. No long-term advantages of colonic resection were found which should be considered only in patients presenting complicated DD.

Long-term outcomes of endonasal surgery for choanal atresia: 28 years experience in an academic medical centre

This study aimed to evaluate the long-term outcomes of endonasal surgical treatment for choanal atresia (CA) and determine possible predictors of recurrence. A retrospective study of 50 cases of CA that were managed endonasally was conducted at an academic tertiary referral centre. Recurrence of disease was assessed with regard to the type and nature of atresia, presence of CHARGE association and stent usage. Bilateral CA cases (n = 76 sides) were operated at an early age and had an incidence of recurrence of 57%, while unilateral cases had a recurrence rate of 25% (3/12). Use of stents did not have a statistically significant effect on the rate of recurrence. However, a significantly higher recurrence rate was noted in patients with purely bony atretic plates (p < 0.001) or CHARGE association (p = 0.049). A tendency towards a higher recurrence rate in bilateral atresias was also found (p = 0.085). The transnasal approach is a safe and effective way to re-establish the nasal choanae. However, appropriate information on the likelihood of recurrence should be included in the preoperative counselling of patients and their parents, especially in cases with bilateral atresia or CHARGE association.

Circumferential pulmonary vein with additional linear ablation for persistent and permanent atrial

To investigate the safety and efficacy of circumferential pulmonary vein with additional linear ablation in treatment of persistent and permanent atrial fibrillation (AF), and to identify possible predictors of recurrence of AF. The clinical data of 127 patients with persistent and permanent AF who had undergone circumferential pulmonary vein with additional linear ablation from January 2006 to December 2006 in multiple electrophysiological centers were collected, success rate and recurrence rate, cardiac function and atrial arrhythmias after ablation, and complications were analyzed. The relationship between the recurrent AF and clinical and echocardiographic variables was investigated. A mean follow-up of 9 +/- 4 months showed that the success rate and recurrence rate were 68.5% and 31.5% respectively. After, both the left atrium diameter, left ventricular end diastole diameter, and left ventricular ejection fraction of the patients with successful ablation were (41 +/- 8) mm, (49 +/- 7) mm, and (61 +/- 8)% respectively, all not significantly different from those before ablation [(43 +/- 7) mm, (48 +/- 6) mm, and (62 +/- 10)% respectively, all P > 0.05]. After ablation the episodes of atrial tachyarrhythmias and atrial premature beat significantly increased (P < 0.05 and P < 0.01). The only complication was ecchymoma that occurred in 3 patients (2.4%). Female gender and left atrium enlargement were risk factors of recurrent AF (P < 0.05 and P < 0.05). Circumferential pulmonary vein with additional linear ablation is a safe and moderately effective treatment for persistent and permanent atrial fibrillation.

Clinical Characteristics and Risk Stratification in Symptomatic and Asymptomatic Patients with Brugada Syndrome: Multicenter Study in Japan

Neither the clinical characteristics nor risk stratification in Brugada syndrome have been clearly determined. We compared the clinical and ECG characteristics of symptomatic and asymptomatic patients with Brugada syndrome to identify new markers for high-risk patients. A total of 188 consecutive individuals with Brugada syndrome (mean age 53 +/- 14 years, 178 males) were enrolled in the Japan Idiopathic Ventricular Fibrillation Study (J-IVFS). Clinical and ECG characteristics were evaluated in three groups of patients: Ventricular fibrillation (VF) group: patients with documented VF (N = 33); Syncope (Sy) group: patients with syncope without documented VF (N = 57); and asymptomatic (As) group: subjects without symptoms (N = 98). Their prognostic parameters were evaluated over a 3-year follow-up period. (1) Clinical characteristics: incidence of past history of atrial fibrillation (AF) was significantly higher in the VF and Sy groups than in the AS group (P = 0.04). (2) On 12-lead ECG, r-J interval in lead V2 and QRS duration in lead V6 were longest in the VF group (P = 0.001, 0.002, respectively). (3) Clinical follow-up: during a mean follow-up period of 37 +/- 16 months, incidences of cardiac events (sudden death and/or VF) were higher in the symptomatic (VF/Sy) groups than in the As group (P < 0.0001). The r-J interval in lead V2 >/= 90 ms and QRS duration in lead V6 >/= 90 ms were found to be possible predictors of recurrence of cardiac events in symptomatic patients. Prolonged QRS duration in precordial leads was prominent in symptomatic patients. This ECG marker may be useful for distinguishing high- from low-risk patients with Brugada syndrome.

Predictors of recurrence in Veteran patients with umbilical hernia: single center experience

Background Different medical and social conditions have been associated with primary and recurrent hernias. Possible predictors of recurrence after elective umbilical hernia repair have not been defined clearly. The aim of this study was to determine factors that predict recurrence in patients after elective repair of umbilical hernias. Methods A 6-year retrospective review of patients with elective umbilical hernia repair at the Dallas VA Medical Center was performed. Clinical and pathologic data were evaluated by univariate analysis to identify predictive factors for recurrence. Results A total of 244 patients underwent elective hernia repair within the study period (male, 96%; mean age, 56 y; Caucasian, 74%; African American, 14%; Hispanic, 8%). Because 15 patients were not compliant with follow-up requirements, 229 were eligible for the study. Ninety-seven underwent suture repair (42.4%) and 132 underwent mesh repair (57.3%). Eleven recurrences were identified (4.8%): 7 in the suture repair group (7.7%) and 4 in the mesh repair group (3%). Univariate analysis showed that patients likely to develop recurrences were as follows: African American (15.6% vs. 3.5%; P = .017), type II diabetics (14.2% vs. 2.6%; P = .002), patients with hyperlipidemia (9.2% vs. 2.6%; P = .028), and human immunodeficiency virus–positive patients (66.6% vs. 3.9%; P = .000). Conclusions Smoking, obesity, size of hernia, type of repair, or chronic obstructive pulmonary disease do not seem to predict recurrence of hernias in our VA population. African Americans, patients with type II diabetes, hyperlipidemia, and positive for human immunodeficiency virus, may have a higher risk for recurrence after elective umbilical hernia repair.

Human Papillomavirus Testing and the Outcome of Treatment for Cervical Intraepithelial Neoplasia

Paraskevaidis, Evangelos; Koliopoulos, George; Alamanos, Yannis; Malamou-Mitsi, Vasiliki; Lolis, Evangelos D.; Kitchener, Henry C.

Stone Recurrence after Lithotripsy in Patients with Recurrent Idiopathic Calcium Urolithiasis: Efficacy of Treatment with Fiuggi Water

A multicentric study was carried out on 384 patients (231 males, mean age 28.3 years; 153 females, mean age 40.8 years) previously treated with extracorporeal shock wave lithotripsy for recurrent idiopathic calcium urolithiasis. Patients were selected and submitted to different types of high fluid intake treatment (oligomineral water with a calcium content of 15 mg/l vs. tap water with a calcium content ranging between 55 and 130 mg/l) to evaluate stone recurrence and to identify any potential risk factors. During follow–up (range 14–34 months, mean 19 months) 44 (23%) of the 192 patients treated with tap water presented recurrence versus 32 (17%) of the 192 patients treated with Fiuggi mineral water, the difference in incidence between the two groups being 6%. Of the possible predictors of recurrence, evaluated at the beginning of follow–up and analyzed in a multivariate statistical study, the 24–hour diuresis and calciuria were seen to be directly related to the recurrence.

Incidence and prediction of stone recurrence after lithotripsy in idiopathic calcium stone patients: a multivariate approach.

In order to evaluate the recurrence of calcium kidney stones, 520 patients (275 males and 245 females), aged 14-79 years, previously treated with lithotripsy were followed up for 23 months on average (median = 24 months; range = 12-48 months), and 101 relapses (10%/year) were recorded. Among the possible predictors of recurrence, measured at the beginning of the follow-up and analyzed in univariate and multivariate statistical ways, age was inversely related with occurrence of event (multivariate t value = -2.12) whereas urinary calcium (UC; t = 2.78), alkaline phosphatase (AP; t = 3.55) and history of previous relapses (t = 2.07) were directly related to the recurrence. The levels of UC were not correlated to those of AP (linear correlation coefficient r = 0.0032), but the combination of their high levels increased the risk of recurrences. The contribution of the other considered factors to stone formation were not significant (sex, family history of stone disease, gallstone, renal failure, serum calcium, phosphate, uric acid, sodium and proteins, urinary phosphate, sodium, magnesium and uric acid.

Recurrence of spontaneous bacterial peritonitis in cirrhosis: frequency and predictive factors.

We investigated whether spontaneous bacterial peritonitis in cirrhosis is a recurrent process and attempted to identify possible predictors of recurrence in 75 consecutive cirrhotics who had recovered from a first episode of spontaneous bacterial peritonitis between January, 1981 and December, 1984 and who were followed closely throughout their illness (follow-up period 10 +/- 13 months; mean +/- S.D.). Thirty-eight patients (51%) developed one or more episodes of spontaneous bacterial peritonitis during follow-up, the probability of recurrence (Kaplan-Meier's method) being 43% at 6 months, 69% at 1 year and 74% at 2 years. Twenty-three variables (age, sex, etiology of cirrhosis, standard liver and renal function tests and characteristics of the first spontaneous bacterial peritonitis) were analyzed as possible predictors of recurrence of spontaneous bacterial peritonitis. In univariate analysis (curves of Kaplan-Meier compared with Mantel-Cox's method), serum bilirubin greater than 4 mg per dl, prothrombin less than or equal to 45% and protein concentration in ascitic fluid less than or equal to 1 gm per dl were significantly (p less than 0.05) associated with a high risk or recurrence of spontaneous bacterial peritonitis. In multivariate analysis (Cox multiple regression model), only ascitic fluid protein concentration (p = 0.005) and prothrombin activity (p = 0.009) were found to be independent predictors of recurrence of spontaneous bacterial peritonitis. Fifty-nine patients (79%) died during follow-up, 18 of them (31%) secondary to spontaneous bacterial peritonitis. The 1-year survival probability in the whole series of patients was 38%.(ABSTRACT TRUNCATED AT 250 WORDS)