Predictor Of Short-term Survival Research Articles

Short-term survival of patients with advanced pancreatic cancer admitted to intensive care unit: a retrospective cohort study.

Little is known about the outcomes of patients with advanced pancreatic cancer admitted to the intensive care unit (ICU) due to medical complications. We designed a study to evaluate their short-term (30-day) survival, predictors of short-term survival and chances of additional chemotherapy. We reviewed all patients with advanced (stage III or IV) pancreatic adenocarcinoma admitted to an ICU in a dedicated Brazilian cancer centre from 2009 to 2018 due to medical reasons. We fitted multivariate regression models to identify predictors of 30-day survival and additional systemic chemotherapy. The study population consisted of 171 patients. Ninety-four patients (55.0%) had Eastern Cooperative Oncology Group (ECOG) performance status 2-4 and 146 (85.4%) had metastatic disease. Most patients (N = 75; 43.9%) were admitted to the ICU during first-line treatment. Median overall survival was 32 days (95% confidence interval (95% CI): 20-49). Survival rate at 30 days was 50.6%. ECOG performance status 2-4 was the only variable associated with lower probability of survival at 30 days in multivariate analysis (odds ratio: 0.28; 95% CI: 0.14-0.54; p < 0.001). Overall, 58 patients (33.9%) received additional chemotherapy and among all patients, 13.5% experienced clinical benefit from this treatment. Patients with advanced pancreatic cancer admitted to the ICU for medical reasons have a dismal prognosis. Early palliative care and refined tools to establish those who would benefit from an ICU trial could help improve patients' care.

Radiological psoas muscle parameters as a reliable tool for detection of sarcopenia and prediction of short-term survival in liver cirrhosis

Loss of skeletal muscle mass or sarcopenia is associated with the development of complications and mortality in patients with liver cirrhosis (LC). Skeletal muscle index (SMI) is the most validated parameter of sarcopenia in clinical studies, but its evaluation is difficult in routine clinical practice. The purpose of the study was to assess the diagnostic concordance between different radiologic skeletal muscle parameters and their relationship with a short-term survival of LC patients. The study involved 147 LC patients, including 90 males and 57 females (55.51±0.97). LC Class A according to Child-Turcotte-Pugh (CTP) was diagnosed in 23 patients, class B in 51 patients, and class C in 73 patients. 50 patients died from LC complications during the follow-up period (489 (306 – 637) days). Skeletal muscle index (SMI), psoas muscle mass index (PMI), and transversal psoas muscle thickness (TPMT) were calculated using the computed tomography at L3 level. The statistical data was processed using the SPSS22 software (© SPSS Inc.). PMI and TPMT were found to be objective parameters of sarcopenia in LC patients having stable diagnostic concordance with SMI (r Spearman’s 0.734, 0.649, p˂0.001; k Cohen’s 0.727, 0.643, p˂0.001, respectively). The use of all three parameters allowed to reveal more patients with a reduced skeletal muscle mass. Sarcopenia was diagnosed in 54.9 % of CTP B patients, 86.3 % of CTP C patients, and was associated with an elevated incidence of ascites, hydrothorax, hepatic encephalopathy, and hypoalbuminemia. Sarcopenic patients were found more likely to have an alcohol-related etiology than viral one (HBV, HCV). The overall survival of patients with low SMI, PMI and TPMT was significantly lower according to Kaplan-Meier analysis. SMI, PMI, and TPMT were independent predictors of LC-associated mortality (HR 2.66, 2.19, 2.21, respectively, p˂0.05) in Cox proportional hazards regression. At least one of the three decreased radiologic skeletal muscle mass parameters was associated with the highest risk of fatal LC complications (HR 3.65, p=0.021). Therefore, the psoas muscle dimensions were considered a reliable tool for detection of sarcopenia and prediction of short-term survival in LC.

The success of machine learning algorithms developed with radiomic features obtained from preoperative contrast-enhanced MRI in the prediction of short-term survival in patients with glioblastoma

Purpose: This study aimed to evaluate the predictability of survival in patients with glioblastoma using a machine learning (ML) model developed with tissue analysis features obtained through preoperative post-contrast T1-weighted images(T1WI).&#x0D; Materials and Methods: The radiomic features of tumors were obtained from postcontrast T1WI of 60 glioblastoma patients. Radiomic properties, density, shape, and textural properties obtained from six matrices were included in the analysis. The patients' three- and six-month survival rates were recorded. Five different ML algorithms were applied to create predictive models [random forest, neural network, linear discriminant analysis(LDA), stochastic gradient descent (SGD), and support vector machine(SMV)]. &#x0D; Results: The mean survival time of the patients was 295.4 days, and the median value was 211.5 (17-1357) days. Among the models developed for three- and six-month survival prediction, the highest success was obtained from the LDA algorithm, in which the AUC values were calculated as 0.88 and 0.78, respectively.&#x0D; Conclusion: Using ML techniques, the success of predicting imaging-based patient survival was very high. With the development and widespread adoption of these techniques, ML models will be useful in deciding on treatment according to survival prediction in glioblastoma.

Survival time after marked reduction in oral intake in terminally ill noncancer patients: A retrospective study.

BackgroundThe prediction of short‐term survival is important for noncancer patients and their families. Although a markedly reduced oral intake by cancer patients suggests a poor prognosis, the survival times of noncancer patients after its onset remain unclear. We herein investigated the time from a marked reduction in oral intake to death in noncancer patients as well as factors associated with their subsequent survival.MethodsWe conducted a retrospective medical record review of noncancer patients who died in our hospital between April 2017 and April 2018. We recorded the day when oral intake markedly decreased and the date of death. We extracted data on age, gender, the Charlson Comorbidities Index, mean daily fluid volume, laboratory test results, and vital signs converted to the Shock Index (SI). We used Cox's proportional hazards models to assess relationships between these factors and survival times after the onset of a markedly reduced oral intake.ResultsWe analyzed data from 44 noncancer patients. The median time from the onset of a markedly reduced oral intake to death was 16.5 days. Based on Cox's proportional hazards models, only SI ≧ 1.0 at the onset of a markedly reduced oral intake correlated with survival times (hazard ratio: 5.89, 95% confidence interval (CI): 1.71‐20.1, P = .005).ConclusionNoncancer patients died a median of 16.5 days after the onset of a markedly reduced oral intake, and SI ≧1.0 correlated with subsequent survival times. These results will provide novel insights into the prognosis of noncancer patients at the end of life.

In-hospital cardiopulmonary resuscitation of patients with cirrhosis: A population-based analysis.

ObjectiveTo examine the epidemiology and outcomes of in-hospital cardiopulmonary resuscitation (CPR) among patients with cirrhosis.MethodsWe used the Texas Inpatient Public Use Data File to identify hospitalizations aged ≥ 18 years with and without cirrhosis during 2009–2014 and those in each group who have undergone in-hospital CPR. Short-term survival (defined as absence of hospital mortality or discharge to hospice) following in-hospital CPR was examined. Multivariate logistic regression modeling was used to assess the prognostic impact of cirrhosis following in-hospital CPR and predictors of short-term survival among cirrhosis hospitalizations.ResultsIn-hospital CPR was reported in 2,511 and 51,969 hospitalizations with and without cirrhosis, respectively. The rate of in-hospital CPR (per 1,000 hospitalizations) was 7.6 and 4.0 among hospitalizations with and without cirrhosis, respectively. The corresponding rate of in-hospital CPR among decedents was 10.7% and 13.4%, respectively. Short-term survival following in-hospital CPR among hospitalizations with and without cirrhosis was 14.9% and 27.3%, respectively, and remained unchanged over time on adjusted analyses among the former (p = 0.1753), while increasing among the latter (p = 0.0404). Cirrhosis was associated with lower odds of short-term survival following in-hospital CPR (adjusted odds ratio [aOR] 0.55 [95% CI: 0.49–0.62]). Lack of health insurance (vs. Medicare) (aOR] 0.47 [95% CI: 0.34–0.67]) and sepsis ([aOR] 0.67 [95% CI: 0.53–85]) were associated with lower odds of short-term survival following in-hospital CPR among cirrhosis hospitalizations.ConclusionsThe rate of in-hospital CPR was nearly 2-fold higher among hospitalizations with cirrhosis than among those without it, though it was used more selectively among the former. Short-term survival following in-hospital CPR remained markedly lower among cirrhosis hospitalizations, while progressively improving among those without cirrhosis. Strategies to increase access to health insurance and improve early identification and control of infection should be explored in future preventive and interventional efforts.

Abstract 364: Association Between Cardiac Arrest to Start of Extracorporeal Cardiopulmonary Resuscitation and Outcome in Patients With Out-of-Hospital Cardiac Arrest Due to Acute Coronary Syndrome

Background: The proper timing of introducing extracorporeal cardiopulmonary resuscitation (ECPR) in patients with out-of-hospital cardiac arrest (OHCA) due to acute coronary syndrome (ACS) has yet to be well-established. Hypothesis: The interval of start of ECPR from cardiac arrest is one of predictors of short-term survival in these particularly ill patients. Methods: Between June 2014 and December 2015, we enrolled a total of 13,491 Japanese OHCA patients who were transported to hospitals in a multicenter, prospective fashion (JAAM-OHCA registry). Following exclusion criteria, 72 patients with OHCA due to ACS who were introduced ECPR until return of spontaneous circulation and underwent emergent PCI and target temperature management were eligible for this study (median 59 years-old; 95% male). We investigated the relationship between the interval of start of ECPR or successfully coronary revascularization from cardiac arrest (collapse-to-ECPR or collapse-to-PCI interval) and the survival at 30 days. Results: Patients with survival at 30 days were 50% (n=36). Age, gender, the prevalence of patients with bystander CPR or ST-elevation and collapse-to-PCI interval were comparable between patients with/without survival. The survival patients had the higher prevalence of initial shockable rhythm and the shorter collapse-to-ECPR interval than those without survival (84 vs 57%, p=0.018; 50 vs 57 min, p=0.045). Receiver operating curve analysis indicated collapse-to-ECPR interval cutoff point of 50 min (area under the curve 0.66, sensitivity 54%, specificity 75%) and collapse-to-PCI interval cutoff point of 135 min (0.65, 64%, and 67%, respectively) for predicting survival at 30 days. Multivariate logistic regression analysis revealed initial shockable rhythm and collapse-to-ECPR interval as the independent predictors of survival (OR 5.71, p=0.015; OR 1.05, p=0.025, respectively). Conclusion: Collapse-to-ECPR interval is a significantly associated with 30 days survival in patients with OHCA due to ACS, while collapse-to-PCI interval is not independent predictor of survival in this study. These findings indicate that time management for start of ECPR from cardiac arrest can be essential for improving OHCA patients’ survival.

Prognostic value of early hemodynamic improvement in patients with acute kidney injury and hemodynamic instability treated with continuous renal replacement therapy

BackgroundSince description of continuous renal replacement therapy (CRRT), these therapies provided improvement in hemodynamic parameters while reducing need for vasopressors in shock. Our aim is to determine whether hemodynamic improvement after 24 h of CRRT is a strong predictor of short term survival. MethodsIn a prospective observational study we enrolled 30 patients admitted to the intensive care unit (ICU)with acute kidney injury (AKI)and hemodynamic instability. AKI defined according to KDIGO criteria. All patients were subjected to continuous renal replacement therapy (CRRT). Based on the hemodynamic response 24 h after CRRT, patients were classified into responders (defined as having a 20% reduction in norepinephrine dosage or a 20% rise in MAP with no increase in norepinephrine), compared with nonresponders . All patients were followed up for 15 days after withdrawal of CRRT. Results of the 30 patients studied, 12 (40%) were responders and 18 (60%) were nonresponders. Responders showed higher mean arterial pressure and urine output during CRRT. SOFA score tended to increase significantly in nonresponders on day 3 (SOFA3) and day 4 (SOFA4) compared to nonresponders (P = 0.01, P = 0.001; respectively). During a 15 days follow-up period, the mortality rate among non responders was 100%, compared to 25% among responders (18 versus 3; P = 0.001). ConclusionEarly hemodynamic improvement after CRRT is strong predictor of short term mortality. Of all scoring systems , post CRRT SOFA score is the most accurate prognostic indicator for mortality.

E/e’ as a Predictor of Short-Term Survival Following ST-Elevation Myocardial Infarction

Background: We examined the usefulness of tissue Doppler imaging in evaluating the diastolic dysfunction and assessed the prognostic value of ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/e’) in unselected patients with acute ST-elevation myocardial infarction (STEMI). Methods: Patients presenting with acute STEMI at Osmania General Hospital, Hyderabad, India between January-2012 and June-2012 were examined in this study. All patients underwent echocardiographic examination comprising Doppler assessment of transmitral flow velocities (peak E-wave velocity) and Doppler tissue imaging of the medial mitral valve annulus (e’). All patients were followed up for 6 months and all-cause mortality was measured as the study endpoint. Role of E/e’ ratio as a predictor of survival after acute STEMI was evaluated by a comparative analysis of patients with E/e’ ≤15 and >15. Results: A total of 50 patients with acute STEMI (mean age: 52.2 ± 13.2 years; 80% males) were analyzed in this study. Of them, 23 (46%) patients had an E/e’ >15. Clinical parameters such as Killip class ≥2 as well as left ventricular ejection fraction of 15. Five (10%) patients died during the 6-month follow-up period. All deaths occurred among patients from the E/e’ >15 group, indicating that E/e’ is an effective predictor of overall survival. Conclusion: E/e’ ratio was identified as a strong predictor of survival after acute myocardial infarction and can be suitable for risk-stratification of patients in this setting. Further studies are warranted to substantiate the findings.

A self-report comorbidity questionnaire for haemodialysis patients.

BackgroundPatients with end-stage renal disease (ESRD) have multiple comorbid conditions. Obtaining comorbidity data from medical records is cumbersome. A self-report comorbidity questionnaire is a useful alternative. Our aim in this study was to examine the predictive value of a self-report comorbidity questionnaire in terms of survival in ESRD patients.MethodsWe studied a prospective cross-sectional cohort of 282 haemodialysis (HD) patients in a single centre. Participants were administered the self-report questionnaire during an HD session. Information on their comorbidities was subsequently obtained from an examination of the patient’s medical records. Levels of agreement between parameters derived from the questionnaire, and from the medical records, were examined. Participants were followed-up for 18 months to collect survival data. The influence on survival of comorbidity scores derived from the self-report data (the Composite Self-report Comorbidity Score [CSCS]) and from medical records data - the Charlson Comorbidity Index [CCI] were compared.ResultsThe level of agreement between the self-report items and those obtained from medical records was almost perfect with respect the presence of diabetes (Kappa score κ 0.97), substantial for heart disease and cancer (κ 0.62 and κ 0.72 respectively), moderate for liver disease (κ 0.51), only fair for lung disease, arthritis, cerebrovascular disease, and depression (κ 0.34, 0.35, 0.34 and 0.29 respectively). The CSCS was strongly predictive of survival in regression models (Nagelkerke R2 value 0.202), with a predictive power similar to that of the CCI (Nagelkerke R2 value 0.211). The influences of these two parameters were additive in the models – suggesting that these parameters make different contributions to the assessment of comorbidity.ConclusionThis self-report comorbidity questionnaire is a viable tool to collect comorbidity data and may have a role in the prediction of short-term survival in patients with end-stage renal disease on haemodialysis. Further work is required in this setting to refine the tool and define its role.

New Scoring System Available at Home Health Care for Prediction of 14 Days Survival in Lung Cancer Complicated with Lymphangitic Carcinomatosis

Objective: Patients with lung cancer often greeted their terminal phase in the treatment at home, and many cases complicated with lymphangitic carcinomatosis took a sudden turn. The aim of the present study was to determine a scoring system available at home health care for prediction of short-term survival of lung cancer complicated with lymphangitic carcinomatosis. Methods: In 14 lung cancer patients with lymphangitic carcinomatosis in our medical care at home, we determined significant close correlated and independent factors for assuming death during 14 days by logisticregression analysis, and made out new scoring system. Moreover, we determined cut-off value on receiveroperating characteristics analysis. Results: In our scoring system calculated as the summation points awarded for the presence of 5 parameters (i.e., systolic blood pressure 100 beats/minute, 3 point; blood oxygen saturation 2 L/minute, 2 point; respiratory frequency>20 times/minute, 3 point), cut-off value was 8 (sensitivity 90%, specificity 68%). Conclusions: We made a new a scoring system available at home health care for prediction of 14 days survival of lung cancer complicated with lymphangitic carcinomatosis assumed systolic blood pressure, pulse rate, respiratory frequency, blood oxygen saturation, and oxygen dose.

The addition of voice prompts to audiovisual feedback and debriefing does not modify CPR quality or outcomes in out of hospital cardiac arrest – A prospective, randomized trial

AimsChest compression quality is a determinant of survival from out-of-hospital cardiac arrest (OHCA). ERC 2005 guidelines recommend the use of technical devices to support rescuers giving compressions. This prospective randomized study reviewed influence of different feedback configurations on survival and compression quality. Materials and methods312 patients suffering an OHCA were randomly allocated to two different feedback configurations. In the limited feedback group a metronome and visual feedback was used. In the extended feedback group voice prompts were added. A training program was completed prior to implementation, performance debriefing was conducted throughout the study. ResultsSurvival did not differ between the extended and limited feedback groups (47.8% vs 43.9%, p=0.49). Average compression depth (mean±SD: 4.74±0.86cm vs 4.84±0.93cm, p=0.31) was similar in both groups. There were no differences in compression rate (103±7 vs 102±5min(−1), p=0.74) or hands-off fraction (16.16%±0.07 to 17.04%±0.07, p=0.38). Bystander CPR, public arrest location, presenting rhythm and chest compression depth were predictors of short term survival (ROSC to ED). ConclusionsEven limited CPR-feedback combined with training and ongoing debriefing leads to high chest compression quality. Bystander CPR, location, rhythm and chest compression depth are determinants of survival from out of hospital cardiac arrest. Addition of voice prompts does neither modify CPR quality nor outcome in OHCA. CC depth significantly influences survival and therefore more focus should be put on correct delivery. Further studies are needed to examine the best configuration of feedback to improve CPR quality and survival. RegistrationClinicalTrials.gov (NCT00449969), http://www.clinicalTrials.gov.

Amplitude spectral area as predictor of short term survival

Purpose: Amplitude Spectral Area (AMSA) can predict defibrillation (DF) success in ventricular fibrillation (VF).1,2 However, it is not known whether this also predicts short term survival. The purpose of this study was to analyze retrospectively whether increased AMSA values were associated with increased short term survival (arrival at the emergency department with a stable, perfusing rhythm of at least 20min duration – ROSC to ED).

VILIP-1 Downregulation in Non-Small Cell Lung Carcinomas: Mechanisms and Prediction of Survival

VILIP-1, a member of the neuronal Ca++ sensor protein family, acts as a tumor suppressor gene in an experimental animal model by inhibiting cell proliferation, adhesion and invasiveness of squamous cell carcinoma cells. Western Blot analysis of human tumor cells showed that VILIP-1 expression was undetectable in several types of human tumor cells, including 11 out of 12 non-small cell lung carcinoma (NSCLC) cell lines. The down-regulation of VILIP-1 was due to loss of VILIP-1 mRNA transcripts. Rearrangements, large gene deletions or mutations were not found. Hypermethylation of the VILIP-1 promoter played an important role in gene silencing. In most VILIP-1-silent cells the VILIP-1 promoter was methylated. In vitro methylation of the VILIP-1 promoter reduced its activity in a promoter-reporter assay. Transcriptional activity of endogenous VILIP-1 promoter was recovered by treatment with 5′-aza-2′-deoxycytidine (5′-Aza-dC). Trichostatin A (TSA), a histone deacetylase inhibitor, potently induced VILIP-1 expression, indicating that histone deacetylation is an additional mechanism of VILIP-1 silencing. TSA increased histone H3 and H4 acetylation in the region of the VILIP-1 promoter. Furthermore, statistical analysis of expression and promoter methylation (n = 150 primary NSCLC samples) showed a significant relationship between promoter methylation and protein expression downregulation as well as between survival and decreased or absent VILIP-1 expression in lung cancer tissues (p<0.0001). VILIP-1 expression is silenced by promoter hypermethylation and histone deacetylation in aggressive NSCLC cell lines and primary tumors and its clinical evaluation could have a role as a predictor of short-term survival in lung cancer patients.

Prediction of Short-term Survival in Patients with Advanced Nonsmall Cell Lung Cancer Following Chemotherapy Based on 2-Deoxy-2-[F-18]fluoro-d-glucose-Positron Emission Tomography: A Feasibility Study

Dynamic positron emission tomography (PET) studies with 2-deoxy-2-[F-18]fluoro-D-glucose (FDG) were performed in patients with advanced nonsmall cell lung cancer (NSCLC) who received palliative chemotherapy to evaluate the impact of full kinetic analysis and assess its value with regard to short or long survival. The evaluation includes 42 metastatic lesions in 14 patients with NSCLC. All patients received a combined chemotherapeutic protocol consisting of vinorelbin and oxaliplatin. The survival data served as reference for the PET data. All patients were examined before onset of chemotherapy and on day 15-21 after onset of the first cycle. The following parameters were retrieved from the dynamic PET studies: standardized uptake value (SUV), fractal dimension, two-compartment model with computation of k1, k2, k3, k4 (unit: 1/min), the fractional blood volume, and the FDG-influx according to Patlak was calculated using the formula (k1 x k3) / (k2 + k3). We used a two-group classification, namely, a short- and long-term survival group based on the median survival time (193 days) as a cutoff. A support vector machines (SVM) analysis was used for classification of the two a prior defined groups. The observed survival times varied from 40 to 392 days with a median survival time of 193 days. Most kinetic parameters demonstrated only small changes mostly declining after one cycle. The change in all kinetic parameters did not correlate to the survival-based classification. The change in SUV was significant between the first and second study (p = 0.006) but without an impact on the prediction of short or long survival. SVM-based analysis revealed the highest correct classification rate (CCR) between short and long survival for the combination of SUV and influx of the first study and SUV, influx, k2, and k4 of the second study with a CCR of 95.2%. The results demonstrate that a full kinetic analysis of the FDG kinetics in NSCLC is helpful for the classification into short or long survival and may be used to identify those patients who may benefit from this palliative chemotherapeutic protocol.

Mental health at the third month of haemodialysis as a predictor of short-term survival

The aim of this study was to evaluate the survival of patients initiating haemodialysis (HD), and to analyse whether low health-related quality of life (HRQoL) levels are predictors of mortality in the short-term, controlling certain variables that had been shown in other studies to have a bearing on survival, and using scores, standardized for age and sex, of the HRQoL measurement tool employed. This is a multicentric prospective study of all patients on HD in all the dialysis units in Asturias, a region with a little over one million inhabitants, from 1 January 2001 to 30 September 2002. A total of 199 patients initiated HD in our region and survived the first 3 months. Of these, 137 patients who remained on HD for at least 3 months had complete responses on HRQoL measures. It was observed that adjusted relative risk (RR) of death increased by 5% for each year of age increase (RR=1.05, 95% CI 1.01-1.09: P=0.006); in the same way, for each increase in the Mental Component Summary (MCS) score, the adjusted RR of death diminished by 4% (RR=0.96, 95% CI 0.94-0.99; P=0.006). Mental health has been shown to be a factor independently associated with mortality; as the MCS score worsens the adjusted RR of death of a patient on HD increases.

Predictors of short-term survival and progression to chemotherapy in patients with advanced colorectal cancer treated with 5-fluorouracil-based regimens.

The aim of this study was to assess in patients with advanced colorectal cancer which factors were associated with short-term survival (6 months or less) and progression to first-line 5-fluorouracil (5-FU) chemotherapy. Three hundred twenty-one consecutive nonselected patients with advanced colorectal cancer were treated with conventional 5-FU-based regimens as first-line treatment from 1988 to 1999. Factors related to patient, tumor, or treatment were analyzed by univariate and multivariate logistic regression analysis by comparing short survivors (SS, those who survived <or=6 months) with those who survived longer than 6 months. The same statistical methods were used to analyze 200 patients, all treated with bolus 5-FU regimens, by comparing who progressed to treatment with those who did not. Sixty-two patients (19.3%) were SS, the remaining 259 patients survived more than 6 months. First-line chemotherapy included 5-FU in all patients; 112 (35%) and 27 (8.4%) patients were offered, after disease progression, second and third-line chemotherapy, respectively. The overall response rate to first-line chemotherapy was 12.9%. No SS patient achieved an objective response. To investigate factors associated with progression to first-line chemotherapy, we considered only those patients treated with bolus 5-FU regimens, to eliminate the variable of regimen used. Ninety-six of them progressed to treatment and 104 did not. At multivariate analysis, SS patients were characterized by the following: right and transverse colon primary (p = 0.006), younger age (p = 0.043), poor performance status (Eastern Cooperative Oncology Group >or= 2) (p = 0.015), elevated (>or=5 microg/l) serum carcinoembryonic antigen (CEA) (p = 0.015), and more than one site of metastatic disease (p < 0.001). Progression to first-line chemotherapy (p < 0.001) was also a strong factor associated with short survival in multivariate analysis; factors predictive of progression were elevated CEA (p = 0.027) and diffuse metastatic disease (p = 0.029). Our data indicate the relevance of some clinical prognostic factors (younger age, poor performance status, elevated CEA, site of primary, number of metastatic sites, resistance to chemotherapy) as independent factors associated with poor survival and progression to first-line chemotherapy in patients with metastatic colorectal cancer treated with conventional 5-FU regimens. Patients identified by these factors as having a poor prognosis and low probability of response to treatment should be considered either for more aggressive regimens or supportive care only: conventional 5-FU treatments do not impact on response or survival.

In-hospital prognosis of patients with acute myocardial infarction complicated by primary ventricular fibrillation.

The in-hospital prognosis of patients with acute myocardial infarction complicated by primary ventricular fibrillation has not been satisfactorily defined. We addressed this question by studying patients with primary ventricular fibrillation derived from a large study (11,712 patients) of intravenous streptokinase in the treatment of acute myocardial infarction. Ventricular fibrillation was considered to be primary when it complicated a first myocardial infarction not associated with heart failure or shock and occurred within 48 hours of hospital admission. The 332 patients with primary ventricular fibrillation represented an overall incidence of 2.8 percent. A significant excess of in-hospital deaths was found in the patients with primary ventricular fibrillation as compared with those in the reference group (10.8 percent vs. 5.9 percent; relative risk, 1.94; 95 percent confidence interval, 1.35 to 2.78). Thrombolytic treatment with intravenous streptokinase did not afford protection against primary ventricular fibrillation. We observed that being over 65 years old had a protective effect against primary ventricular fibrillation (relative risk, 0.6; 95 percent confidence interval, 0.45 to 0.80). Our data do not indicate whether primary ventricular fibrillation is simply a marker for patients at increased risk of death or a direct cause of the increase in mortality. Our results do show, however, that primary ventricular fibrillation occurring in a coronary care unit is a negative predictor of short-term survival in patients with acute myocardial infarction.

Significance of haemodynamic variables in coronary care unit for prediction of survival after acute myocardial infarction.

In order to assess the value of haemodynamic monitoring in the coronary care unit for long term prognosis after recovery of an acute myocardial infarction, the records of two groups of consecutive patients were reviewed retrospectively. From 254 patients, 32 (13%) died in the hospital and nine patients had to be excluded from subsequent follow-up for various reasons. Four year mortality among the 213 patients who were discharged from the hospital and could be followed up was 26%. Of the haemodynamic variables measured on admission a high pulmonary capillary wedge pressure, exceeding 18 mmHg, and a low mixed venous oxygen saturation, less than 60%, were not only associated with a high hospital but also with a high four year mortality, whereas a low systolic blood pressure (less than 100 mmHg), an important prognosticator during admission to hospital, was only of minor significance thereafter. A negative value on admission of a specific index 0.24 X systolic blood pressure (mmHg) -0.217 X pulmonary capillary wedge pressure (mmHg)+0.234 X mixed venous oxygen saturation (%)-13.1 developed for the prediction of short term survival was also associated with a much higher four year mortality than a positive value. Low cardiac index on admission could be correlated with high mortality during the first two years after discharge, whereas only 9% of patients with a higher cardiac index died. Haemodynamic monitoring in the coronary care unit is thus not only relevant for the immediate prognosis, but a high mortality risk during hospital stay persists for several years after discharge.