Predictive Factors Of Early Death Research Articles

Construction and Validation of Prediction Models of Risk Factors for Early Death in Patients With Metastatic Melanoma

To construct nomogram models to predict the risk factors for early death in patients with metastatic melanoma (MM). The study covered 2138 cases from the Surveillance, Epidemiology, and End Results Program (SEER) database and all these patients were diagnosed with MM between 2010 and 2015. Logistic regression was performed to identify independent risk factors affecting early death in MM patients. These risk factors were then used to construct nomograms of all-cause early death and cancer-specific early death. The efficacy of the model was assessed with receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). In addition, external validation of the model was performed with clinicopathologic data of 105 patients diagnosed with MM at Sichuan Cancer Hospital between January 2015 and January 2020. According to the results of logistic regression, marital status, the primary site, N staging, surgery, chemotherapy, bone metastases, liver metastases, lung metastases, and brain metastases could be defined as independent predictive factors for early death. Based on these factors, 2 nomograms were plotted to predict the risks of all-cause early death and cancer-specific early death, respectively. For the models for all-cause and cancer-specific early death, the areas under the curve (AUCs) for the training group were 0.751 (95% confidence interval [CI]: 0.726-0.776) and 0.740 (95% CI: 0.714-0.765), respectively. The AUCs for the internal validation group were 0.759 (95% CI: 0.722-0.797) and 0.757 (95% CI: 0.718-0.780), respectively, while the AUCs for the external validation group were 0.750 (95% CI: 0.649-0.850) and 0.741 (95% CI: 0.644-0.838), respectively. The calibration curves showed high agreement between the predicted and the observed probabilities. DCA analysis indicated high clinical application value of the models. The nomogram models demonstrated good performance in predicting early death in MM patients and can be used to help clinical oncologists develop more individualized treatment strategies.

SIOG2023-4-OA-108 - Older women with gynecological cancer: Predictive factors of early death, a cohort study

SIOG2023-4-OA-108 - Older women with gynecological cancer: Predictive factors of early death, a cohort study

Predictive factors of early death in older women with gynecological cancer: A prospective cohort study.

e24034 Background: Comprehensive geriatric assessment (CGA) correlate with risk of early mortality in older adult patients. Methods: a prospective cohort study. older woman with a recent diagnosis of gynecological cancer were from eight community hospitals and cancer center in Northeast Brazil and were recruited during their first medical appointment at the outpatient oncologic clinic. A basal CGA was done before the treatment decision (ADL, Charlson Comorbidity Index- CCI, Karnofsky Performance status – KPS, GDS15, IPAQ, MMSE, MNA, MNA-SF, PS, PPS, Polipharmacy, QLQc30, TUG). During the follow up of six months, information about the treatments performed, the targeted interventions and early death was collected. Overall survival was estimated using the Kaplan–Meier method, and survival curves were compared using the Log rank test for categorical variables. A multivariate Cox proportional hazards model was used to select early death risk factors. Results: 274 patients with a median age of 72 years, 13.5% died within 180 days. 29,7% cervical cancer, 122 (44,5%),endometrial cancer, 53(19,3%) ovary cancer and 17( 6,2%) vulvar cancer. The mean global QL was higher among survivors and the probability of survival was higher in patients who had better QL (p < 0.001). After adjustments for risk factors (cervical cancer topography, metastatic disease and Karnofsky ≤ 50), Global QoL was a protective factor (HR = 0.99; 95%CI 0.98-1.00; p = 0.031). Cervical cancer topography 95%CI HR = 2.28 1.18-4.40 p = 0.014). MNA < 17 95 %CIHR = 9.72 (3.85-24.50 , p < 0.001) TUG ( HR = 3,87 ; 95 % CI 1,93 - 7,74 p = 0.004). Conclusions: A better score in the Global QoL assessment , a good nutritional status by MNA and low risk of falls by TUG were protective factor for early death in older women with gynecological cancer.Cervical cancer is the highest risk of early death topography. Risk factors for early death can be identified in the admission of older women with gynecological cancer, allowing better care planning.

A Study on Early Death Prognosis Model in Adult Patients with Secondary Hemophagocytic Lymphohistiocytosis.

Background The mortality risks for secondary hemophagocytic lymphohistiocytosis in the induction stage and investigated prognostic factors need to be further discussed. Objective The aim of this study is to establish a clinical model for predicting early death in adult patients with secondary hemophagocytic lymphohistiocytosis. Design, Participants, and Main Measures. The baseline characteristics, laboratory examination results, and 8-week survival rate of 139 adult sHLH patients diagnosed from January 2018 to December 2018 were analyzed retrospectively, and a prognostic model was constructed with low-risk (score 0–2), medium-risk (score 3), and high-risk (score ≥ 4) as parameters. Key Results. Univariate analysis confirmed that early death was not related to the type of HLH but significantly related to the patient's response to first-line treatment. The peripheral blood cell count was significantly decreased, C-reactive protein was higher, glutamyl transpeptidase and total bilirubin were higher, albumin was significantly lower, urea nitrogen was higher, hypocalcemia and hyponatremia, deep organ hemorrhage and D-dimer increased, cardiac function damage and HLH central involvement, sCD25 increased, and EB virus infection were predictive factors of early death. In the multivariate model, patients' response to first-line treatment was a good predictor of overall survival, and hypocalcemia and deep organ bleeding were associated with poor survival. The risk factors were scored and graded according to the risk ratio. The 8-week overall survival rates of the low-risk group (82 cases), medium-risk group (36 cases), and high-risk group (21 cases) were 85.4%, 52.8%, and 23.8%, respectively (P < 0.001). Conclusions The early death of sHLH patients is closely related to some laboratory examination results. Attention should be paid to identify high-risk patients, choose effective first-line induction therapy, achieve deep remission as soon as possible, prevent deep organ bleeding, correct electrolyte disorders, and improve the early survival rate of sHLH patients.

SIOG2021-0162 - Predictive factors for early death identified by the comprehensive geriatric assessment in patients with gastrointestinal tumors (git): A prospective cohort study with 513 patients

SIOG2021-0162 - Predictive factors for early death identified by the comprehensive geriatric assessment in patients with gastrointestinal tumors (git): A prospective cohort study with 513 patients

Disseminated Intravascular Coagulation Score Evolution in 48 Hours Predicts Early Death in Newly-Diagnosed Chemotherapy-Treated Acute Promyelocytic Leukemia Patients

Introduction Acute Promyelocytic Leukemia (APL) prognosis has largely improved over the past decades and is now the acute leukemia with the highest cure rates. However, its early death rate, which reaches 30% in several real-world studies, is the main obstacle to achieving lifelong remission in most patients. Several reports have suggested a potential role of the Disseminated Intravascular Coagulation (DIC) Score of the International Society of Thrombosis and Hemostasis as a marker of bleeding and death in APL. Since the APL-induced coagulopathy and hyperfibrinolysis are responsible for most early deaths, a method to assess the severity of the coagulopathy could guide the daily patient management and the intensity of the blood products used. We aimed to test the hypothesis of whether the improvement of the DIC Score through coagulopathy support can improve the rate of early death in APL. Methods This retrospective, single-center study, included consecutively admitted patients with newly diagnosed genetically confirmed Acute Promyelocytic Leukemia between 2000 and 2020, who were treated with ATRA + anthracycline protocols and prednisolone 0.5 mg/kg differentiation syndrome prophylaxis. All patients received platelets, fibrinogen, and/or fresh frozen plasma according to published clinical indications. Baseline demographics and clinical data were collected, and the DIC Score was calculated at diagnosis and after 48 hours for each patient, using fibrinogen, platelets, prothrombin time and d-dimers. "DIC Score improvement" was defined as an increase of ≥1 point in the calculated score at 48 hours; a stable or decreasing score were considered "no-improvement". A 30-day follow-up for each patient was conducted, and any death during this period was considered in the early-death group. Statistical analysis was performed using Stata, with chi-square test and Mann-Whitney test for differences between groups, and logistic regression for the analysis of predictors of early death. Results A total of 67 patients were included, after excluding 9 patients for missing coagulation values, 8 for first-line arsenic trioxide treatment, and 7 patients for death within 48 hours of hospital admission. The median age was 53 years (25-82), and 29.9% of patients were aged &amp;gt;60 years old. The 30-day mortality rate for this cohort was 31.3%. Comparing the baseline differences between the two groups, the only statistically significant difference detected was a less frequent improvement of the DIC Score over 48 hours in the early-death group (42.86% versus 76.09% in the remaining patients, p=0.008). There was no difference in the Sanz Risk distribution nor age between the two groups. The univariate analysis of predictors of death in 30 days (logistic regression) yielded age &amp;gt;60 years and 48h-improvement of the DIC Score as potential predictors of death. A multivariate analysis model was built incorporating these 2 variables with the Sanz Risk (the number of events in this study permitted only a 3-variable prognostic model), and it identified age&amp;gt;60 years (OR 4.84 [1.37-17.10]; p=0.014) and the lack of a 48-hour improvement in the DIC Score (OR 5.46 [1.61-18.47]; p=0.006) as independent predictors of early death. In patients under 60 years old, having no improvement in the DIC Score over 48 hours is still associated with almost five times superior odds of 30-day mortality (OR 4.55; p=0.038). Conclusion In this cohort, we identified a lack of DIC Score improvement and age&amp;gt;60 years as independent predictive factors of early death in APL. These findings identified a new independent predictor of early death using a dynamic DIC Score assessment, which is easily accessible and calculated, and illustrate how this score can be applied daily in the clinical care of APL patients. Together with the current APL treatment strategies, the intensification of measures to control the leukemia-associated coagulopathy in patients who do not show a DIC Score improvement in the first 48 hours after diagnosis could decrease the early death rate in this otherwise highly-curable leukemia. Disclosures Brioso Infante: Astellas: Speakers Bureau; Novartis: Speakers Bureau.

Baseline laboratory tests as predictors of early death risk in 746 elderly oncologic patients: A prospective cohort study.

e23039 Background: The elderly population is the thoroughly affected by new cases of cancer, as well as by its complications. The occurrence of early death (in the first six months after diagnosis) is one of the most important outcomes to be studied in this population. This study aims to identify if simple baseline laboratory tests can be used as predictive factors for early death in older cancer patients. Methods: Prospective cohort enrolled elderly patients ≥ 60 years with a recent cancer diagnosis admitted between 2015 -2017. Sociodemographic, tumor-related and laboratorial (leukocytes, creatinine, platelets and hemoglobin) variables were collected at admission and analyzed. Survival analysis (Kaplan-Meier) and Cox proportional hazard regression was performed. The outcome was a six-month death. Descriptive, univariate and multivariate analysis of Cox proportional hazards and Kaplan-Meier global survival were performed. Results: A total of 746 patients with an average of 71 (± 7.4) years were eligible. 16.5% died in the first six months after diagnosis. Risk factors for early death were controlled by age. Leukocytes &lt; 4,000 / mm3 or &gt; 12,000 / mm3 (HR 2.51 IC95% 1.68-3.75), Creatinine &gt; 1.7mg / dL (HR 2.14 95% CI 1.37-3.36), Platelets &lt; 150,000 / mm3 or &gt; 300,000 / mm3 (HR 1.92 CI 95% 1.31-2.80) and Hemoglobin &lt; 12 g / dL if female, or &lt; 13 g / dL, if male (HR 1.89 95% CI 1.27-2.83) were all associated with greater risk of dying in the first six months after diagnosis (log rank &lt; 0.001). Conclusions: Baseline laboratory tests performed at the hospital admission of the elderly cancer patient may be a simple way to help the clinician to identify patients at higher risk of early death.

Sa1259 HIGH BLOOD UREA NITROGEN LEVEL CAN BE A PREDICTIVE CLINICAL FACTOR FOR EARLY DEATH AFTER PERCUTANEOUS ENDOSCOPIC GASTROSTOMY.

Percutaneous endoscopic gastrostomy (PEG) is accepted as a method for administering enteral feeding to patients with swallowing difficulties. However, the prevalence of complications and early death after PEG is considerably high. To decrease the incidence of early mortality after PEG, it is very important to identify risk factors for early death after PEG. The aim of our study was to determine factors that could predict early death within 30 days following PEG. We retrospectively analyzed the records of all patients who underwent PEG at Kure Medical Center and Chugoku Cancer Center from April 2008 to July 2017. We examined clinical and preoperative laboratory data and extracted data of predictive factors for early death after PEG by using univariate and multivariate analyses. A total of 993 patients—459 female (46.2%) and 534 male (53.8%) patients with a mean age of 78 years—were assessed. Predictors of poor survival after PEG included age ≥81 years (odds ratio [OR], 1.92; 95% confidence interval [CI], 1.1–3.2; P<0.01), white blood cell count ≥9000/μL (OR, 1.91; 95% CI, 1.2–3.1; P<0.005), L-lactate dehydrogenase level ≥300 U/L (OR, 2.51; 95% CI, 1.5–4.3; P<0.005), blood urea nitrogen level ≥34 mg/dL (OR, 2.75; 95% CI, 1.6–4.8; P<0.001), C-reactive protein level ≥2.6 mg/dL (OR 2.72; 95% CI, 1.6–4.4; P<0.001), total protein level ≤5.8 mg/dL (OR, 2.4; 95% CI, 1.3–4.4; P<0.05), albumin level ≤2.7 mg/dL (OR, 3.2; 95% CI, 1.7–6.1; P<0.005), hemoglobin level ≤9.4 g/dL (OR, 2.6; 95% CI, 1.5–4.2; P<0.001), and cholinesterase level ≤172 IU/L (OR, 7.2; 95% CI, 1.6–32; P<0.05). Multivariate analysis on predictive factors for early death revealed high blood urea nitrogen level (OR, 5.45; 95% CI, 1.7–16.9; P<0.05) as an independent risk factor. High blood urea nitrogen level may be a useful predictive clinical factor for early death after PEG. If patients have a history of high blood urea nitrogen levels, PEG should be considered carefully.

Predictive factors of early death after a comprehensive geriatric assessment in elderly cancer patients.

e20530 Background: Objective data for decision making about treatment options in the elderly population with cancer are lacking. The purpose of this study is to analyze predictive factors of early ...

Predictive factors of early death during 100 days after a comprehensive geriatric assessment in older patients with cancer: A prospective cohort study of 576 patients.

9511 Background: The purpose of this study is to analyse predictive factors of early death in older patients with cancer during 100 days after a geriatric comprehensive assessment (CGA) in order to...

Comorbidity, Use of Common Medications, and Risk of Early Death in Patients with Localized or Locally Advanced Prostate Cancer

In this paper, we analyze predictive factors for early death from comorbidity (defined as death within 3 years from diagnosis and unrelated to prostate cancer) in patients with localized or locally advanced prostate cancer. Such information may guide individually tailored treatment or observation strategies, and help to avoid overtreatment. We retrospectively analyzed baseline parameters including information on comorbidity and medication use among 177 patients (median age at diagnosis 70 years). Actuarial survival analyses were performed. During the first 3 years, two patients (1.1%) died from progressive prostate cancer after they had developed distant metastases. The risk of dying from other causes (3.4%) was numerically higher, although not to a statistically significant degree. Six patients who died from other causes had age-adjusted Charlson comorbidity index (CCI) scores ≥5 (CCI is a sum score where each comorbid condition is assigned with a score depending on the risk of dying associated with this condition). The main comorbidity was cardiovascular disease. The two statistically significant predictive factors were medication use and age-adjusted CCI score ≥5 (univariate analysis). However, medication use was not an independent factor as all patients with age-adjusted CCI score ≥5 also used at least one class of medication. Median survival was 30 months in patients with age-adjusted CCI score ≥5. Prediction of non-prostate cancer death may be important to prevent overtreatment in patients who are more threatened by comorbidity. Our data suggest that simple parameters such as use of medications vs. none, or presence of serious cardiac disease vs. none, are not sufficient, and that age-adjusted CCI scores outperform the other factors included in our analysis.

Development and validation of a model that predicts early death among cancer patients participating in phase I clinical trials investigating cytotoxics

Selecting patients for phase 1 studies remains challenging. Given the lack of clear and reliable guidance for the estimation of life expectancy, we retrospectively assessed predictive factors of early death (within 90 days following inclusion) among these patients. Two hundred fifty-seven consecutive cancer patients enrolled in phase I studies investigating cytotoxics at Oscar Lambret Cancer Center and Institut Claudius Regaud were included in the development database. Univariate and multivariate analyses (logistic regression model) were undertaken to determine the prognostic factors. A probability tree described the rate of early death in the different prognostic subgroups. This prognostic model was then evaluated on a second independent cohort of 128 patients treated at Léon Bérard Cancer Center. The median overall survival was 8.4 months in the dataset population, and the rate of early death was 15%. In multivariate analysis, the two prognostic factors for early death were albumin <38 g/l (OR = 5.21) and lymphocytes <700/mm(3) (OR = 3.88). According to these two parameters, three prognostic subgroups were defined with early death rates of, respectively, 8/121 (6%), 19/119 (16%) and 13/17 (76%). In the validation dataset, the rates of early death according to three prognostic groups were 13/68 (19%), 20/57 (35%) and 3/3 (100%), respectively. We do not recommend the enrolment of patients with albumin level below 38g/l and lymphocytes count below 700/mm(3), in phase 1 trial investigating cytotoxics. Our model is helpful to discriminate "patients with reasonable life expectancy" as defined in most phase 1 protocols.

Development and validation of a prediction model for early death among cancer patients participating in phase I clinical trials of new cytotoxic agents

2537 Background: Selecting cancer patients for phase I clinical trials of new cytotoxic agents remains an ethical and clinical dilemma. Given the lack of clear and reliable guidance for the estimation of life expectancy, we retrospectively assessed predictive factors for early death (within 90 days following inclusion) among these patients. Methods: 137 consecutive cancer patients enrolled in cytotoxic phase I studies at Oscar Lambret Cancer Centre were included in the model development database. Univariate and multivariate analysis (logistic regression model) were undertaken to determine the predictive factors. A probability tree described the rate of early death in the different prognostic subgroups. This score was then evaluated on a second independent cohort of 128 patients treated at Léon Berard Cancer Centre and checked for consistency. Results: The median overall survival was 8.3 months in the development dataset population; the rate of early death was 17%. The univariate analysis identified the following poor prognostic factors: Melanoma (OR=4.06), Pancreas cancer (OR=3.02), Performance status>0 (OR=2.15), lymphocytes<700/mm3 (OR=2.20), granulocytes ≥ 5,000/mm3 (OR=2.55) and albumin<38 g/l (OR=4.34). In multivariate analyses, the 2 predictive factors for early death were: albumin <38 g/l (OR=5.01 [1.97–10.2],p=0.0001) and lymphocytes count up to 700/mm3 (OR=3.45 [1.39–6.71], p=0.0008). According to these 2 parameters, 3 prognostic subgroups were defined with early death rates of, respectively 6/81 (7%), 6/43 (14%) and 12/13 (92%). In the validation dataset, the rates in the 3 subgroups were, respectively, 13/68 (19%), 20/57 (35%) and 3/3 (100%), thus confirming the value of both predictive factors. Conclusions: According to these results, we do not recommend the trial enrollment of patients with albumin < 38g/l and lymphocytes < 700/mm3. Our model is helpful to objectively discriminate ‘patients with reasonable life expectancy‘ as defined in most protocols. Similar studies are necessary for phase I clinical trials investigating molecular targeted therapies and those investigating immunotherapies. No significant financial relationships to disclose.

Early death during chemotherapy in patients with small-cell lung cancer: derivation of a prognostic index for toxic death and progression.

Based on an increased frequency of early death (death within the first treatment cycle) in our two latest randomized trials of combination chemotherapy in small-cell lung cancer (SCLC), we wanted to identify patients at risk of early non-toxic death (ENTD) and early toxic death (ETD). Data were stored in a database and logistic regression analyses were performed to identify predictive factors for early death. During the first cycle, 118 out of 937 patients (12.6%) died. In 38 patients (4%), the cause of death was sepsis. Significant risk factors were age, performance status (PS), lactate dehydrogenase (LDH) and treatment with epipodophyllotoxins and platinum in the first cycle (EP). Risk factors for ENTD were age, PS and LDH. Extensive stage had a hazard ratio of 1.9 (P = 0.07). Risk factors for ETD were EP, PS and LDH, whereas age and stage were not. For EP, the hazard ratio was as high as 6.7 (P = 0.0001). We introduced a simple prognostic algorithm including performance status, LDH and age. Using a prognostic algorithm to exclude poor-risk patients from trials, we could minimize early death, improve long-term survival and increase the survival differences between different regimens. We suggest that other groups evaluate our algorithm and exclude poor prognosis patients from trials of dose intensification. © 1999 Cancer Research Campaign

Ten-year experience with surgical treatment of partial atrioventricular septal defect: Risk factors in the early postoperative period

Partial atrioventricular septal defects are electively repaired with good results. However, recent reports suggest that such repair is potentially a high-risk surgical procedure. Our aim was to determine the risk factors of adverse outcome early after surgical treatment of atrioventricular septal defects in our hospital. A retrospective study was done in 100 consecutive patients from 2 months to 50.6 years old (median 3.6 years) who underwent surgical correction between January 1984 and December 1993. An intermediate form of the lesion was noted in 31% of cases. Congestive heart failure occurred in 50% of cases. Preoperative left atrioventricular valve incompetence (moderate to severe) was present in 63% of patients. Severe abnormalities of left subvalvular apparatus were noted in 28% of patients. The cleft of the left atrioventricular valve was closed in 76% of cases. The study was done to determine risk factors associated with hospital mortality (13%), postoperative residual left atrioventricular valve incompetence (23%), and early reoperation (14%) within the first 30 postoperative days. Univariate analysis showed that age at the date of operation and cleft closure were not related to an early adverse outcome. A stepwise logistic regression with variables selected by univariate analysis identified infections and severe abnormalities of left subvalvular apparatus as predictive factors of early death (odds ratios, 28.07 and 6.18, respectively), preoperative left atrioventricular valve regurgitation as a predictive factor of residual postoperative left atrioventricular valve regurgitation (odds ratio, 5.34), and severe abnormalities of left subvalvular apparatus as a predictive factor of early reoperation (odds ratio, 5.27). These results emphasize the importance of the severity of the morphologic features of the left subvalvular apparatus, the occurrence of early postoperative infections, and the presence of residual left atrioventricular valve regurgitation as risk factors in the early period after surgical correction of partial atrioventricular septal defects. (J T horac C ardiovasc S urg 1996;112:14-20)

Acute monocytic leukaemia in adults: treatment and prognosis in 99 cases

Acute monocytic leukaemia (AMoL) was diagnosed in 99 adults, aged 18-85 years (median 56) over a period of 10 years. Sixty-five patients had extramedullary leukaemia, 13 had clinical signs of leucostasis, and 19 had disseminated intravascular coagulation. Four patients died before receiving any treatment, 12 received supportive care only and seven received low dose AraC, but only one of them responded. Seventy-six patients received intensive chemotherapy, 72 of them with an anthracycline-AraC based regimen, with or without an epipodophyllotoxin. Fifteen patients died within 7 d of diagnosis, due to leucostasis in nine cases. Predictive factors for early death were advanced age, leucostasis, fever, leucocytes above 100 x 10(9)/l, and renal failure. Fifty (66%) of the patients treated intensively reached complete remission (CR). Advanced age, fever and complex cytogenetic abnormalities were significantly associated with a lower CR rate. Median actuarial disease-free survival was 20.5 months, and was not significantly influenced by any pretreatment parameter. Five patients relapsed in the central nervous system (CNS), in spite of systematic CNS prophylaxis. No differences in CR rates were seen with the three anthracycline-AraC based regimens used in our patients. Significant differences in disease-free survival were seen between them, however, suggesting that early consolidation chemotherapy and, more hypothetically, epipodophyllotoxin agents could prolong remission duration in AMoL.