Prediction Of Long-term Prognosis Research Articles

Gender differences in the relationship between serum uric acid and the long-term prognosis in heart failure: a nationwide study

BackgroundSerum uric acid (SUA) is an important pathogenetic and prognostic factor for heart failure (HF). Gender differences are apparent in HF. Furthermore, gender differences also exist in the association between SUA and prognosis in various cardiovascular diseases. However, the gender difference for SUA in the prediction of long-term prognosis in HF is still ambiguous.MethodsA total of 1593 HF patients (897 men, 696 women) from the National Health and Nutrition Examination Survey (NHANES) 1999–2018 cycle were enrolled in our final analysis. Participants were categorized according to gender-specific SUA tertile. We assessed the association between SUA and long-term prognosis of HF patients, defined as all-cause mortality and cardiovascular mortality, in different genders via Kaplan–Meier curve analysis, Cox proportional hazard model, and Fine-Gray competing risk model. The restricted cubic spline (RCS) was performed to investigate the dose-response relationship between SUA and outcomes.ResultsGender differences exist in demographic characteristics, clinical parameters, laboratory tests, and medication of HF patients. After a median follow-up of 127 months (95% CI 120–134 months), there were 853 all-cause deaths (493 events in men, 360 events in women) and 361 cardiovascular deaths (206 events in men, 155 events in women). Kaplan-Meier analysis showed that SUA had gender difference in the prediction of cardiovascular mortality (Log-rank p < 0.001, for male, Log-rank p = 0.150, for female), but not in all-cause mortality. Multivariate Cox regression analysis revealed that elevated SUA levels were associated with higher all-cause mortality and cardiovascular mortality in men (HR 1.11, 95% CI 1.05-1.18, p < 0.001, for all-cause death; HR 1.18, 95% CI 1.09-1.28, p < 0.001, for cardiovascular death), but not in women (HR 1.05, 95% CI 0.98-1.12, p = 0.186, for all-cause death; HR 1.01, 95% CI 0.91-1.12, p = 0.902, for cardiovascular death). Even using non-cardiovascular death as a competitive risk, adjusted Fine-Gray model also illustrated that SUA was an independent predictor of cardiovascular death in men (SHR 1.17, 95% CI 1.08-1.27, p < 0.001), but not in women (SHR 0.98, 95% CI 0.87 − 1.10, p = 0.690).ConclusionsGender differences in the association between SUA and long-term prognosis of HF existed. SUA was an independent prognostic predictor for long-term outcomes of HF in men, but not in women.

Predictive value of two different definitions of contrast-associated acute kidney injury for long-term major adverse kidney events in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

It remains controversial whether contrast-associated acute kidney injury (CA-AKI) is associated with long-term major adverse kidney events (MAKE) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). By the Acute Kidney Injury Network (AKIN) criteria, CA-AKI was defined as an increase in serum creatinine ≥ 0.3 mg/dL or 50% from baseline within 48 h after PCI; or an increase in serum creatinine ≥ 0.5 mg/dL or 25% within 72 h by the contrast-induced nephropathy (CIN) criteria. The primary endpoint was 1-year MAKE, defined as a composite of all-cause mortality and persistent renal dysfunction. A total of 402 patients were finally included in this study. The primary endpoint occurred in 29 (7.2%) patients. There was a significant association between CA-AKI and 1-year MAKE assessed by both the AKIN (hazard ratios [HR]: 11.58, 95% confidence interval [CI]: 4.29-31.24, p = 0.000) and CIN (HR: 6.45, 95% CI: 2.56-16.25, p = 0.000) definitions. However, the AKIN definition (HR: 4.95, 95% CI: 1.17-21.02, p = 0.030) was more reliable in the prediction of persistent renal dysfunction than CIN definition (HR: 4.08, 95% CI: 0.99-16.87, p = 0.052). Additionally, the area under receiver operating characteristic curve was larger for predicting 1-year MAKE with the AKIN definition than CIN definition (0.742 vs. 0.727). In patients with STEMI undergoing primary PCI, CA-AKI was significantly associated with 1-year MAKE. Moreover, the AKIN definition might be more reliable in the prediction of long-term prognosis.

Serial Evaluation of Sequential Organ Failure Assessment Score in Predicting 1-Year Mortality in Critically Ill Patients

Introduction: Prediction of long-term prognosis or outcome in the intensive care unit (ICU) is important for prognostication and administration purposes. Sequential Organ Failure Assessment (SOFA) score was developed to estimate organ failure in sepsis patients. However, organ failures have been associated with mortality, and hence SOFA score has been validated as an outcome measure. To the best of our knowledge, the association of SOFA, and serial SOFA score with 1-year mortality was not well established. Materials and method: This was a retrospective observational cross sectional study using the existing record of patients admitted to general ICU Sultan Ahmad Shah Medical Centre from the 1st June 2017 to the 30thMay 2018. Data was collected from patients’ daily clinical charts and medical records. SOFA score on day-1 until day-3 and on discharge were recorded and subsequently delta SOFA was calculated. Results: A total of 120 patients’ data were collected. SOFA score within 3 days of admission predicted 1-year mortality, with the highest prediction for on SOFA score on discharge from ICU. Serial SOFA score measured within 24 hours (day 1 to day 2) and 48 hours (day 1 to day 3) did not predict mortality, but delta SOFA involving SOFA on discharged did. Cardiovascular and renal were the most significant individual component of SOFA score that contributed to 1-year mortality. Conclusions: SOFA score measured on discharge from ICU plays the key important factor in contributing to the prediction of 1-year mortality. Cardiovascular and renal were the most significant component that warrant risk stratification measures using the parameters.

Baseline IgG-Fc N-glycosylation profile is associated with long-term outcome in a cohort of early inflammatory arthritis patients

BackgroundRheumatoid arthritis (RA) is a chronic autoimmune disease for which prediction of long-term prognosis from disease’s outset is not clinically feasible. The importance of immunoglobulin G (IgG) and its Fc N-glycosylation in inflammation is well-known and studies described its relevance for several autoimmune diseases, including RA. Herein we assessed the association between IgG N-glycoforms and disease prognosis at 2 years in an early inflammatory arthritis cohort.MethodsSera from 118 patients with early inflammatory arthritis naïve to treatment sampled at baseline were used to obtain IgG Fc glycopeptides, which were then analyzed in a subclass-specific manner by liquid chromatography coupled to mass spectrometry (LC-MS). Patients were prospectively followed and a favorable prognosis at 2 years was assessed by a combined index as remission or low disease activity (DAS28 < 3.2) and normal functionality (HAQ ≤ 0.25) while on treatment with conventional synthetic DMARDs and never used biologic DMARDs.ResultsWe observed a significant association between high levels of IgG2/3 Fc galactosylation (effect 0.627 and adjusted p value 0.036 for the fully galactosylated glycoform H5N4F1; effect −0.551 and adjusted p value 0.04963 for the agalactosylated H3N4F1) and favorable outcome after 2 years of treatment. The inclusion of IgG glycoprofiling in a multivariate analysis to predict the outcome (with HAQ, DAS28, RF, and ACPA included in the model) did not improve the prognostic performance of the model.ConclusionPending confirmation of these findings in larger cohorts, IgG glycosylation levels could be used as a prognostic marker in early arthritis, to overcome the limitations of the current prognostic tools.

The applicability of established clinical and histopathological risk factors for tumor recurrence during long-term postoperative care in meningioma patients

Risk factors to predict late-onset tumor recurrence in meningioma patients are urgently needed to schedule control intervals during long-term follow-up. We therefore analyzed the value of established risk factors for postoperative meningioma recurrence for the prediction of long-term prognosis. Correlations of clinical and histopathological variables with tumor relapse after 3, 5, and 10 years following microsurgery were analyzed in uni- and multivariate analyses, and compared to findings in the entire cohort. In the entire cohort (N = 1218), skull base location (HR: 1.51, 95%CI 1.05–2.16; p = .026), Simpson ≥ IV resections (HR: 2.41, 95%CI 1.52–3.84; p < .001), high-grade histology (HR: 3.70, 95%CI 2.50–5.47; p < .001), and male gender (HR: 1.46, 95%CI 1.01–2.11; p = .042) were independent risk factors for recurrence. Skull base location (HR: 1.92, 95%CI 1.17–3.17; p = .010 and HR: 2.02, 95%CI 1.04–3.95; p = .038) and high-grade histology (HR: 1.87, 95%CI 1.04–3.38; p = .038 and HR: 2.29, 95%CI 1.07–4.01; p = .034) but not subtotal resection (HR: 1.53, 95%CI .68–3.45; p = .303 and HR: 1.75, 95%CI .52–5.96; p = .369) remained correlated with recurrence after a recurrence-free follow-up of ≥ 3 and ≥ 5 years, respectively. Postoperative tumor volume was related with recurrence in general (p < .001) but not beyond a follow-up of ≥ 3 years (p > .05). In 147 patients with a follow-up of ≥ 10 years, ten recurrences occurred and were not correlated with any of the analyzed variables. Skull base tumor location and high-grade histology but not the extent of resection should be considered when scheduling the long-term follow-up after meningioma surgery. Recurrences ≥ 10 years after surgery are rare, and predictors are lacking.

Ability of serum annexin A1 to predict 6-month poor clinical outcome following aneurysmal subarachnoid hemorrhage

BackgroundAnnexin A1 might be neuroprotective and serum annexin A1 concentrations were markedly declined after severe traumatic brain injury. We determine dthe ability of serum annexin A1 to assess severity and predict prognosis after aneurysmal subarachnoid hemorrhage (aSAH). MethodsWe included 157 aSAH patients and 157 healthy subjects. Serum annexin A1 measurements were measured. A poor outcome was designated as Glasgow outcome scale score of 1–3. Multivariate logistic regression analysis was applied to identify predictors of a poor 6-month outcome. ResultsSerum annexin A1 concentrations were significantly lower in patients than in controls. Annexin A1 concentrations were strongly correlated with the World Federation of Neurological Surgeons scale (WFNS) score, Hunt-Hess score, Glasgow coma scale score and modified Fisher score. A total of 59 patients (37.6%) experienced a poor outcome. Serum annexin A1, WFNS score and modified Fisher score emerged as the 3 independent predictors for a poor outcome after aSAH. Under ROC curve analysis, serum annexin A1 had a fair accuracy to predict a poor outcome, AUC of serum annexin A1 concentration was equivalent to those of WFNS score and modified Fisher score and AUC of combination of the 3 factors significantly exceeded that of each one alone. ConclusionsAnnexin A1 may be involved in the occurrence and progression of secondary brain injury after aSAH. Detection of serum annexin A1 may have certain ability for assessment of severity and prediction of long-term prognosis following aSAH.

Prediction of long-term prognosis of age-related macular degeneration treated by hemorheologic therapy using baseline laboratory indicators - Experimental-clinical model.

66 patients with dry form of AMD were treated using rheohaemapheresis with an individual follow-up period of more than 5 years. The patients' initial laboratory data was split in two subgroups based on treatment success and analysed using discriminant analysis (analysis of the linear and quadratic models using the automated and interactive step-wise approach) by means of the Systat 13 software. Prediction of prognosis based on the initial laboratory parameters was correct in 79% of unsuccessfully treated patients, allowing for early detection of high-risk patients. With the use of a quadratic model, the prediction was correct in 100% of unsuccessfully treated patients and in 75% of successfully treated patients. Implementation of discriminant analysis is a promising method for prediction of prognosis, especially when the patient is at risk of AMD progression, which allows for early and more intensive monitoring and treatment.

4939Clinical significance of global strain estimated by 3D speckle tracking acutely after onset of ST-elevation myocardial infarction on prediction of long term prognosis

Abstract Background Three-dimensional (3D) speckle tracking echocardiography (STE) is a novel method for assessing cardiac function because of free form out-of-plane motion effects. Aim To explore the role of 3D-STE for prediction of the long term prognosis in patients with a first-time ST elevation acute myocardial infarction (STEMI). Methods A total of 238 patients (mean age 64.6 years) with a first-time STEMI treated with reperfusion therapy were enrolled in our study. Twenty four hours after admission, standard 2D echocardiography and 3D full volume imaging were obtained and strain parameters (GLS: global longitudinal strain, GCS: global circumferential strain) were calculated using 4D LV analysis. Infarct size was measured with single-photon emission computed tomography imaging 7 to 14 days after onset. We followed them for median 94 months (inter quartile range: 69–109 months). The primary end point was the major adverse cardiac and cerebrovascular events (MACE: cardiac death, non-fatal MI, heart failure requiring intravenous diuretics administration and stroke). The patients with persistent chronic atrial fibrillation, poor image quality, emergency bypass surgery were excluded. Results During follow up periods, 78 patients experienced MACE (26 cardiac death, 48 heart failure, 29 non-fatal MI, 5 stroke) and 48 patients died (22 non-cardiac death). In multivariate analysis, 3D-GLS was the strongest predictor for MACE. Kaplan-Meier Curve demonstrated that 3D-GLS &gt;−11.4 was the independent predictor for MACE (Log-rank χ2=73.818, p&lt;0.0001). When combined with 3D-GCS &gt;−19.2, the patients with higher value both of 3D-GLS and 3D-GCS were extremely high risk. The figure shows the Kaplan-Meier curve according to the 4 groups based on the cut-off values determinded by ROC curves. Conclusions Global strain estimated by 3D-STE immediately onset of STEMI was useful tool for the prediction of long term prognosis. Acknowledgement/Funding None

Myocardial constructive work is a predictor of long-term outcomes in patients with heart failure undergoing cardiac resynchronization therapy

Recent studies have shown that myocardial constructive work (CW) assessed by pressure strain loops (PSLs) is an independent predictor of cardiac resynchronization therapy response (CRT + ). To assess the role of global myocardial CW in the prediction of long-term outcome of patients undergoing CRT. 2D-standard and speckle-tracking echocardiography were performed in 166 CRT candidates (mean age: 66 ± 10 years, males: 69%, QRS duration: 165 ± 19 ms) before CRT implantation and at 6-month follow-up. Left-ventricular (LV) end-systolic volume reduction > 15% at 6-month follow-up defined CRT + and occurred in 48 (29%) patients. After a median FU of 4 years (range: 1.3–5 years), all-cause death occurred in 28 patients (17%), cardiac death in 14 patients (8%). At multivariable Cox-regression analysis, including age, ischemic etiology, septal flash, and CRT + , CW and age were the only prognostic predictors. A CW ≤ 888 mmHg% (AUC 0.71, P = 0.007 and AUC 0.67, P = 0.004 for cardiac and all-cause mortality) was associated with an increased cardiac and all-cause mortality risk. The estimation of left-ventricular CW by PSLs curves is a relatively novel tool, which allows the prediction of long-term prognosis in CRT candidates.

Early prediction of sarcoidosis prognosis with HLA typing: a 5 year follow-up study.

Background: A wide range of HLA-DR alleles have been associated with sarcoidosis either in terms of disease phenotype or extra pulmonary involvement, however the effect on non-resolution in different ethnic groups is not fully understood. The aim of this study was to investigate whether disease characterics and HLA-DRB1 alleles may early reflect non resolution in sarcoidosis. Methods: 91 patients who were diagnosed in Cukurova University Faculty of Medicine Department of Chest Diseases between 1993-2012 and were followed up until June 2017 were included in the study. All patients underwent HLA analysis by the Sequence Specific Oligonucleotide Prob (SSOP) method. Fifteen of them were excluded from the study group due to lost of follow-up (n=6) and not yet passed 5 years since diagnosis (n=9). Complete resolution at 5th year was defined according to the predefined standard criteria (ACCESS). Results: The resolution rate was 51.3%. The HLA-DRB1*14 allele was significantly higher in patients without resolution (11.8 vs 1.3%)(p=0.006). According to multivariate logistic regression analysis the independent risk factors of non resolution were female gender (OR: 12.6; 95%CI: 2.1-74.9, p=0.005), HLA DRB1*14 allele (OR:51.9; 95%CI: 3.6-735.8, p=0.000), baseline TLCO<75%(predicted) (OR:3.8; 95%CI: 1.1-13.7, p=0.028), extra-pulmonary involvement (OR:3.7; 95%CI: 1.0-13.1, p=0.038) and advanced stage at baseline (OR: 8.3; 95%CI: 1.9-35.4, p=0.001). Conclusions: HLA-DRB1*14 alleles, lower baseline TLCO, advanced stage, female gender or the presence of extra-pulmonary involvement could predict long term non-resolution in sarcoidosis. Early prediction of long term prognosis may affect treatment decisions and avoid further deterioration in these patient groups. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 184-191).

Superiority of Serum Cystatin C Over Creatinine in Prediction of Long-Term Prognosis at Discharge From ICU.

Renal outcomes after critical illness are seldom assessed despite strong correlation between chronic kidney disease and survival. Outside hospital, renal dysfunction is more strongly associated with mortality when assessed by serum cystatin C than by creatinine. The relationship between creatinine and longer term mortality might be particularly weak in survivors of critical illness. Retrospective observational cohort study. In 3,077 adult ICU survivors, we compared ICU discharge cystatin C and creatinine and their association with 1-year mortality. Exclusions were death within 72 hours of ICU discharge, ICU stay less than 24 hours, and end-stage renal disease. None. During ICU admission, serum cystatin C and creatinine diverged, so that by ICU discharge, almost twice as many patients had glomerular filtration rate less than 60 mL/min/1.73 m when estimated from cystatin C compared with glomerular filtration rate estimated from creatinine, 44% versus 26%. In 743 patients without acute kidney injury, where ICU discharge renal function should reflect ongoing baseline, discharge glomerular filtration rate estimated from creatinine consistently overestimated follow-up glomerular filtration rate estimated from creatinine, whereas ICU discharge glomerular filtration rate estimated from cystatin C well matched follow-up chronic kidney disease status. By 1 year, 535 (17.4%) had died. In survival analysis adjusted for age, sex, and comorbidity, cystatin C was near-linearly associated with increased mortality, hazard ratio equals to 1.78 (95% CI, 1.46-2.18), 75th versus 25th centile. Conversely, creatinine demonstrated a J-shaped relationship with mortality, so that in the majority of patients, there was no significant association with survival, hazard ratio equals to 1.03 (0.87-1.2), 75th versus 25th centile. After adjustment for both creatinine and cystatin C levels, higher discharge creatinine was then associated with lower long-term mortality. In contrast to creatinine, cystatin C consistently associated with long-term mortality, identifying patients at both high and low risk, and better correlated with follow-up renal function. Conversely, lower creatinine relative to cystatin C appeared to confer adverse prognosis, confounding creatinine interpretation in isolation. Cystatin C warrants further investigation as a more meaningful measure of renal function after critical illness.

Validation of the Japanese histologic classification 2013 of immunoglobulin A nephropathy for prediction of long-term prognosis in a Japanese single-center cohort.

A new Japanese histologic classification (JHC) of immunoglobulin A nephropathy (IgAN) for prediction of long-term prognosis was proposed in 2013. The goal of this study was to validate the JHC system in a Japanese single-center cohort. A retrospective study was conducted in 198 Japanese adult patients with IgAN. Clinical findings including blood pressure, urinary protein, estimated glomerular filtration rate (eGFR), and outcomes were evaluated in these patients. The glomerular lesion percentage score (GLPS) [number of glomeruli with cellular crescents, fibrocellular crescents, global sclerosis, segmental sclerosis, or fibrous crescents/number of total obtained glomeruli × 100 (%)] was assessed in each patient and categorized into histologic grades (HGs) of HG1 (<25 %), HG2 (25-49 %), and HG3/4 (≥50 %). Associations of GLPS (HG) with disease progression (50 % eGFR decline or end-stage renal disease requiring dialysis) within 10 years after biopsy and the rate of annual eGFR decline were examined. During a median follow-up period of 12.0 years after biopsy, disease progression occurred in 12.8 % (12/94) of HG1 patients, 32.3 % (21/65) of HG2 patients, and 46.2 % (18/39) of HG3/4 patients. The risk of disease progression was significantly higher in the HG2 and HG3/4 groups than in the HG1 group (odds ratios: 3.3 and 5.9 vs. 1). A higher GLPS was significantly associated with a higher risk of disease progression and a greater annual eGFR decline. The newly proposed JHC system 2013 based on GLPS (HG) was well correlated with long-term prognosis in our cohort of Japanese adult patients with IgAN.

Abstract 3490: Perfusion Defect Is Associated With Poor Prognosis Of Lacunar Infarction.

Backgrounds: Small subcortical infarctions are caused by lipohyalinosis and also by microatheroma and microembolism. However, it remained still unknown which clinical or radiological findings could be useful for prediction of long-term prognosis. We sought to find whether perfusion images are associated with long-term poor clinical status. Methods: We reviewed 197 patients who admitted from January, 2009 to January, 2011, and who had the lacunae(≤20mm) in the perforator territory of the middle cerebral artery on diffusion-weight MRI(DWI) within 3 days of onset. T2 weighted imaging and perfusion-weighted MRI(PWI) were evaluated in all participants. We divided the patients according to the existence of perfusion defect and analyzed the association between perfusion defect and poor outcomes, defined as modified Rankin score(mRS)≥3 at 3 months Results: Among a total 197 patients(69 Men; 63.8±11.2y), 78 subjects(52 Men; 62.4±12.1y) had the perfusion defect on PWI. The subject with perfusion defect had the higher frequency of current smoker(P=0.03) and poor outcomes at 3 months (P=0.002), compared to those without. There was no difference in other risk factors, infarct size or parent artery stenosis between two groups. Multivariate binary regression analysis showed that the perfusion defect was strongly associated with poor outcomes at 3 months(P=0.002;adjusted OR 4.21; adjusted 95% CI,1.73-10.28). The propensity score regression analysis also indicated that perfusion defect could predict the poor prognosis(Propensity score adjusted OR,3.88). Conclusion: Perfusion defect of small vessel disease seems to have the influence on the recovery after lacunae. Further study may be needed to find whether the PWI can be useful for diagnosing the various etiology of lacunae.

The Effect of Atenolol on NT‐proBNP and Troponin in Asymptomatic Cats with Severe Left Ventricular Hypertrophy because of Hypertrophic Cardiomyopathy: A Pilot Study

Atenolol often is used empirically in cats with hypertrophic cardiomyopathy (HCM) before the onset of heart failure, although evidence of efficacy is lacking. Cardiac biomarkers play a critical role in the early detection of subclinical cardiac disease, in the prediction of long-term prognosis, and in monitoring the response to therapy in humans. Circulating concentrations of the biomarkers N-terminal pro-B type natriuretic peptide (NT-proBNP) and cardiac troponin I (cTnI) will decrease after chronic administration of atenolol PO to cats with severe HCM but no signs of heart failure. Six Maine Coon or Maine Coon cross cats with severe HCM. Cats were treated with atenolol (12.5 mg PO q12 h) for 30 days. No cat had left ventricular dynamic outflow tract obstruction caused by systolic anterior motion of the mitral valve. The concentrations of NT-proBNP and cTnI were assayed before and on the last day of drug administration. There was no statistically significant change in NT-proBNP (median before, 394 pmol/L; range, 71-1,500 pmol/L; median after, 439 pmol/L; range, 24-1,500 pmol/L; P = .63) or in cTnI (median before, 0.24 ng/mL; range, 0.10-0.97 ng/mL; median after, 0.28 ng/mL; range, 0.09-1.0 ng/mL; P = .69) after administration of atenolol. Atenolol administration did not decrease NT-proBNP or cTnI concentrations in cats with severe left ventricular hypertrophy caused by hypertrophic cardiomyopathy. These results suggest that atenolol did not decrease myocardial ischemia and myocyte death in these cats. A larger clinical trial is warranted to verify these findings.

Effect of pathohistologic complete remission (pCR) rate on the prediction of long-term prognosis following chemoradiotherapy (XRT) with cetuximab (Cet), capecitabine (CAP), and oxaliplatin (OX; Cet-CAPOX) in patients (pts) with locally advanced rectal cancer (LARC).

e14035 Background: Preoperative XRT with Cet, CAP and OX (Cet-CAPOX) simultaneously to 50.4 Gy in fractions of 1.8 Gy has shown to be feasible, with no unexpected acute toxicity or increased perioperative morbidity, in LARC (Rödel et al., Int J Radiat Oncol Biol Phys., 2008). However, this regimen failed to show an increase in pathohistological response, incl. pCR rate, compared to reported data of 5-FU based XRT. Here, long-term results are reported. Methods: 58 pts with LARC were included in the phase I/II trial, with 40 pts evaluable for long-term efficacy (phase II). Pts characteristics: median age 63 (37-83) yrs, ECOG PS 0/1 80%/20%, at pre-therapeutic staging: cT2/3/4 3%/85%/12%, cN0/+ 20%/80%. Results: Following XRT, quality assessed TME surgery was done in all pts: low anterior resection in 70%, APR in 23%, Hartmann`s procedure in 7%. Histopathologically confirmed R0 rate was 95%. Pathology reports: ypT0N0 10%, ypT1-2N0 30%, ypT1-2N+ 5%, ypT3-4N0 25%, ypT3-4N+ 30%. Pathological tumor regression grading (TRG) according to Dworak et al.: TRG 4 (pCR) 10%, TRG 3 (>50% of tumor mass eradicated) 40%, TRG 2 (25-50%) 30%, TRG 0/1 20%. Adjuvant chemotherapy (not protocol defined) was given in 70%: 5FU/FA or CAP alone 30%, with OX 40%. With a median follow-up of 40 (3-49) months, 8 of 40 pts. (20%) have died: 1 with local R2 status and occult peritoneal metastases at staging died 5 weeks after surgery due to peritoneal tumor progression. No further locoregional failure occurred in 39 pts up to now. 3 pts. (8%) died unrelated to the malignant disease. 4 pts. (10%) developed distant metastases (liver: 1; lung: 1, both: 1, peritoneum: 1). Disease-free survival at 4 years was 77%. Conclusions: Notwithstanding the limited number of pts and follow-up time, the disappointingly poor results in terms of pathohistological response (incl. pCR) did not translate into poor long-term results. Taken into account the results of the EXPERT-C trial (Dewdney et al., ASCO GI 2011), pCR and TRG are likely insufficient parameters to assess the benefit of a cetuximab-containing perioperative XRT regimen.

The Role of Neopterin in Atherogenesis and Cardiovascular Risk Assessment

Neopterin is produced by human and primate monocyte/macrophages upon activation by pro-inflammatory stimuli like Th1-type cytokine interferon-gamma. Neopterin has pro-oxidative properties, which have been demonstrated in vitro in physicochemical and cell culture studies and also in in vivo experiments, e.g. the Langendorff perfusion model of rat hearts. In the past several years, the measurement of neopterin concentrations in body fluids including serum, urine and cerebrospinal fluid has revealed a potential role of this molecule in the prediction of long-term prognosis in both patients with cancer and those with systemic infections such as HIV-1 infection. Moreover, elevated neopterin concentrations have been reported in patients with coronary disease compared to controls and in recent years it has become apparent that increased neopterin concentrations are an independent marker for cardiovascular disease and a predictor of future cardiovascular events in patients with coronary artery disease. Current data suggest that the diagnostic performance of neopterin testing is comparable to that of well established biomarkers such as C-reactive protein and cholesterol plasma levels. The present article reviews the role of neopterin in the pathogenesis of cardiovascular disease and as a marker of coronary artery disease progression.

P3-33: Analysis of tpte-interval for prediction of long term prognosis in cardiovascular disease

P3-33: Analysis of tpte-interval for prediction of long term prognosis in cardiovascular disease

Incremental value of myocardial viability for prediction of long-term prognosis in surgically revascularized patients with left ventricular dysfunction

Incremental value of myocardial viability for prediction of long-term prognosis in surgically revascularized patients with left ventricular dysfunction

Prediction of long-term prognosis in 12 169 men referred for cardiac rehabilitation.

Predicting the risk of cardiac and all-cause death in patients with established coronary heart disease is important in counseling the individual and designing risk-stratified rehabilitation and secondary prevention programs. Cox proportional hazards and Kaplan-Meier survival curves were thus completed on initial assessment data obtained from patients referred to an outpatient cardiac rehabilitation center. A single-center prospective observational design took peak cardiorespiratory exercise test data for 12 169 male rehabilitation candidates aged 55.0+/-9.6 years (7096 myocardial infarctions [MIs], 3077 coronary artery bypass grafts [CABGs], and 1996 documented cases of ischemic heart disease [IHD]). A follow-up of 4 to 29 years (median, 7.9) yielded 107 698 man-years of experience. Entry data were tested for associations with time to cardiac and all-cause death. We recorded 1336 cardiac deaths (953 MI, 225 CABG, and 158 IHD) and 2352 all-cause deaths. A powerful predictor of cardiac and all-cause mortality was measured peak oxygen intake (VO2peak). For the overall sample, values of <15, 15 to 22, and >22 mL/kg per minute yielded respective multivariate adjusted hazard ratios of 1.00, 0.62, and 0.39 for cardiac and 1.00, 0.66, and 0.45 for all-cause deaths. For the separate diagnostic categories, apart from VO2peak, the only other significant predictors of cardiac death common to all 3 were smoking and digoxin, and for all-cause death, age, smoking, digoxin, and diabetes. Exercise capacity, as determined by direct measurement of VO2peak, exerts a major long-term influence on prognosis in men after MI, CABG, or IHD and can play a valuable role in risk stratification and counseling.

74 ONE YEAR FOLLOW-UP OUTCOME OF VENTILATORY ASSISTED INFANTS (B.Wt. &gt;1500G) CORRELATED WITH PRENATAL AND PERINATAL FACTORS

The risk potential of isolated prenatal or perinatal event is often inadequate and misleading in the prediction of long term prognosis. In order to assess the value of cumulative prenatal and perinatal factors as they relate to outcome, 42 infants (B.Wt. >1500 G) who received ventilatory assistance (VA) neonatally were compared to 42 non-ventilated matched controls (C). Matching variables were race, sex, gestational age and birth weight. Prenatal, paranatal and postnatal factors cumulatively were evaluated in conjunction with physical, neurological, audiological, opthalmological developmental assessments in the VA and C infants at 1 yr. of age. The VA infants had significantly higher incidence of prolonged rupture of membranes, second and third trimester bleeding, stained amniotic fluid, lower Apgar scores, seizures, congenital heart disease, RDS, apnea, infection and blood transfusions associated with abnormal physical, neurological and developmental findings. Cumulative prenatal and perinatal data were arranged in a discriminating function and predicted whether or not the infant will require VA in 85% of cases. Multiple factors obtained cumulatively in the prenatal, paranatal and postnatal periods may be more useful in evaluation of risk factors for long term prognosis.