Predictor Of Worse Outcome Research Articles

A Comprehensive Assessment of Cardiomyopathies through Cardiovascular Magnetic Resonance: Focus on the Pediatric Population.

Cardiomyopathies (CMPs) are a heterogeneous group of diseases that involve the myocardium and result in systolic or diastolic impairment of the cardiac muscle, potentially leading to heart failure, malignant arrhythmias, or sudden cardiac death. Occurrence in pediatric age is rare but has been associated with worse outcomes. Non-invasive cardiac imaging techniques, integrated with clinical, genetic, and electrocardiographic data, have shown a pivotal role in the clinical work-up of such diseases by defining structural alterations and assessing potential complications. Above all modalities, cardiovascular magnetic resonance (CMR) has emerged as a powerful tool complementary to echocardiography to confirm diagnosis, provide prognostic information and guide therapeutic strategies secondary to its high spatial and temporal resolution, lack of ionizing radiation, and good reproducibility. Moreover, CMR can provide in vivo tissue characterization of the myocardial tissue aiding the identification of structural pathologic changes such as replacement or diffuse fibrosis, which are predictors of worse outcomes. Large prospective randomized studies are needed for further validation of CMR in the context of childhood CMPs. This review aims to highlight the role of advanced imaging with CMR in CMPs with particular reference to the dilated, hypertrophic and non-compacted phenotypes, which are more commonly seen in children.

Comparative Influence of Primary Healthcare Payer Types on Patient Outcomes After Lung Transplantation

<h3>Purpose</h3> Optimal outcomes in patients undergoing lung transplantation requires significant utilization of resources. We, therefore, evaluated the association of primary payer type with outcomes after lung transplantation. <h3>Methods</h3> Using the UNOS (United Network for Organ Sharing) registry we studied 15129 first-time lung transplant recipients from January 2000 to December 2017 and compared all-cause mortality at 1 year. Single lung (N=4524) and double lung (N=10605) recipients were subgrouped by payer type: Medicaid (32% and 27% respectively), Medicare (26% and 18%), and commercial insurance (42% and 54%). <h3>Results</h3> Primary payer type was not significantly associated with inferior outcomes at 1 year following both single-lung (P=0.447) and double lung transplant (P=0.531). Insurance was also not a predictor of worse outcomes following single lung transplant after 3 years (P=0.107). However, insurance type was associated with different outcomes in double lung recipients at 3 years (P=0.028) and remained significant predictors of early mortality after adjustment for covariates in multivariate Cox proportional hazard ratio analyses (P<0.05). <h3>Conclusion</h3> These data are among the first to provide insight into the impact of insurance status on patient outcomes for a modern cohort of lung transplant recipients. All-cause mortality after single-lung and double-lung transplantation did not differ significantly by payer type after 1 year. However, primary payer type was associated with 3-year outcomes following double lung transplant. More research is needed to confirm and define the reasons for insurance type playing a role in outcomes after double lung transplant as compared to single lung transplant.

Short- and long-term outcome and predictors in an international cohort of patients with neuro-COVID-19.

Background and purposeDespite the increasing number of reports on the spectrum of neurological manifestations of COVID‐19 (neuro‐COVID), few studies have assessed short‐ and long‐term outcome of the disease.MethodsThis is a cohort study enrolling adult patients with neuro‐COVID seen in neurological consultation. Data were collected prospectively or retrospectively in the European Academy of Neurology NEuro‐covid ReGistrY ((ENERGY). The outcome at discharge was measured using the modified Rankin Scale and defined as ‘stable/improved’ if the modified Rankin Scale score was equal to or lower than the pre‐morbid score, ‘worse’ if the score was higher than the pre‐morbid score. Status at 6 months was also recorded. Demographic and clinical variables were assessed as predictors of outcome at discharge and 6 months.ResultsFrom July 2020 to March 2021, 971 patients from 19 countries were included. 810 (83.4%) were hospitalized. 432 (53.3%) were discharged with worse functional status. Older age, stupor/coma, stroke and intensive care unit (ICU) admission were predictors of worse outcome at discharge. 132 (16.3%) died in hospital. Older age, cancer, cardiovascular complications, refractory shock, stupor/coma and ICU admission were associated with death. 262 were followed for 6 months. Acute stroke or ataxia, ICU admission and degree of functional impairment at discharge were predictors of worse outcome. 65/221 hospitalized patients (29.4%) and 10/32 non‐hospitalized patients (24.4%) experienced persisting neurological symptoms/signs. 10/262 patients (3.8%) developed new neurological complaints during the 6 months of follow‐up.ConclusionsNeuro‐COVID is a severe disease associated with worse functional status at discharge, particularly in older subjects and those with comorbidities and acute complications of infection.

Abstract P2-02-04: In early breast cancer, the ratios of neutrophils, monocyctes and platelets to lymphocytes significantly correlate with the presence of subsets of circulating tumor cells in blood and disseminated tumor cells in the bone marrow

Abstract Background: Circulating tumor cells (CTCs) are the precursors of metastasis and while travelling through the peripheral blood, they crosstalk with different types of blood cells before they finally reach distant organs to settle down as disseminated tumor cells (DTCs). Proinflammatory markers include the neutrophil lymphocyte ratio (NLR), the platelet lymphocyte ratio (PLR) as well as the monocyte lymphocyte ratio (MLR) and the presence of tumor cells as well as specific proinflammatory markers are two independent predictors of worse outcome in breast cancer (BC). However, little is known about the correlation between NLR, PLR, MLR and subsets of CTCs as well as DTCs in early, non-metastatic BC. Here we evaluated the correlation of NLR, PLR, MLR and the presence of epithelial CTCs (eCTCs), CTCs in epithelial mesenchymal transition (EMT-CTCs) as well as DTCs to better identify patients at risk, to monitor treatment reponse and probably adjust therapeutic options. Methods: The counts of peripheral neutrophils, lymphocytes, monocytes and platelets to determine NLR, PLR and MLR as well as clinicopathological data during diagnosis were retrospectively recorded for 171 patients (pts) diagnosed with BC from July 2006 to December 2012, before the start of therapy. NLR, PLR and MLR were calculated from peripheral blood cell counts and their optimal cutoff levels were determined by the 75% percentile resulting in the following values: NLR: 3.13, MLR: 0.39 and PLR: 222.3, respectively. 170/171 pts were analyzed for DTCs by immunocytochemistry using the pan-cytokeratin antibodyA45-B/B3 (Clodronate intake was recommended in case of DTC-positivity). CTCs were determined in 155/171 pts applying positive immunomagnetic selection using the AdnaTest BreastCancerSelect. The recovered cDNA was tested for the presence of eCTCs and EMT-CTCs using the AdnaTests BreastCancerDetect and EMTDetect. Pts were considered CTC-positive if at least one of the two tests were positive. Statistical analysis included descriptive reporting, U-test for group differences, Rho correlations for dependencies and Fisher's chi-square test for distributional differences. Rho correlations were used to assess the relationship between NLR, PLR, MLR and tumor cells as well as progression-free survival (PFS) and overall survival (OS). Results: DTCs were detected in 34% of the pts and at least one CTC-subtype was found in 28% of the pts. Whereas the presence of DTCs was not associated with PFS or OS, the presence of CTCs significantly correlated with a shorter PFS (p=0.046) and OS (p=0.018). However, neither eCTCs nor EMT-CTSs alone were of prognostic significance. Enhanced lymphocyte (p=0.025) and monocyte counts (p=0.039) as well as a low PLR (p=0.032) significantly correlated with a reduced PFS in pts still alive whereas an enhanced MLR showed a high correlation with a shorter PFS (p=0.007) and OS (p=0.021) in deceased pts. Whereas MLR significantly correlated with the presence of EMT-CTCs (p=0.045), the presence of eCTCs significantly associated with an elevated NLR (p=0.003) and enhanced lymphocyte (p=0.007) as well as monocyte counts (p=0.012). No significant correlations were found for NLR, PLR and MLR with DTCs, however, DTC-positive pts, harboring a lower PLR, had a significant shorter OS (p=0.043). Conclusion: Here we show that proinflammatory markers in blood are closely related to the presence of different CTC subsets in early BC while no direct correlation was found for tumor cell spread to the bone. These findings might improve the prognostication of these pts and probably help to monitor response to therapy and adjust treatment options. Citation Format: Sabine Kasimir-Bauer, Ebru Karaaslan, Olaf Hars, Ann-Kathrin Bittner, Oliver Hoffmann, Rainer Kimmig. In early breast cancer, the ratios of neutrophils, monocyctes and platelets to lymphocytes significantly correlate with the presence of subsets of circulating tumor cells in blood and disseminated tumor cells in the bone marrow [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-02-04.

CDK7 Predicts Worse Outcome in Head and Neck Squamous-Cell Cancer.

Simple SummaryHead and neck squamous-cell cancer (HNSCC) is one of the most common cancer entities worldwide. Still, prognosis is rather poor, and therapeutic regimes come with harsh side-effects. In cancer research, certain biomolecules serve an important role as biomarkers that help to gain deeper insights into tumor biology. In this study, we sought to investigate the clinical implications of CDK7 and pMED1 as potential biomarkers in HNSCC patients. Therefore, we measured the levels of the above-mentioned proteins within tissue sections of our cohort using suitable software. Possible correlations of protein abundancy and clinicopathological features might help to guide future therapeutic decisions. We found that high levels of CDK7 in patients’ tumor tissue point to lower survival and disease-free survival rates. There are current studies that investigate CDK7 as a therapeutic target in drug therapy. Our study provides a rationale that such therapies might benefit HNSCC patients.HNSCC is the sixth most common cancer worldwide and the prognosis is still poor. Here, we investigated the prognostic implications of CDK7 and pMED1. Both proteins affect transcription, and their expression is altered throughout different tumor entities. pMED1 is phosphorylated by CDK7. Importantly, CDK7 and MED1 have been ascribed prognostic implications by various studies. However, their prognostic value in head and neck squamous-cell cancer (HNSCC) remains elusive. We applied immunohistochemical staining of CDK7 and pMED1 on our large and clinically well-characterized HNSCC tissue cohort comprising 419 patients. Software-aided quantification of staining intensity was performed as a measure of protein expression. The following results were linked to the clinicopathological features of our cohort and correlated in different tissue types (primary tumor, lymph node metastasis, distant metastasis, recurrence). Upregulation CDK7 was associated with worse 5-year overall survival as well as disease-free survival in HNSCC while being independent of other known prognostic factors such as p16-status. Also, CDK7 expression was significantly elevated in immune cell infiltrated tumors. In HNSCC CDK7 might serve as a novel prognostic marker to indicate the prognosis of patients. Furthermore, in vitro studies proved the feasibility of CDK7 inhibition with attenuating effects on cell proliferation underlining its remarkable translational potential for future therapeutic regimes.

Posterior Circulation Endovascular Thrombectomy for Large Vessels Occlusion in Patients Presenting with NIHSS Score ≤ 10.

Mechanical thrombectomy (MT) is currently the gold standard treatment for ischemic stroke due to large vessel occlusion (LVO). However, the evidence of clinical usefulness of MT in posterior circulation LVO (pc-LVO) is still doubtful compared to the anterior circulation, especially in patients with mild neurological symptoms. The database of 10 high-volume stroke centers in Europe, including a period of three year and a half, was screened for patients with an acute basilar artery occlusion or a single dominant vertebral artery occlusion (“functional” BAO) presenting with a NIHSS ≤10, and with at least 3 months follow-up. A total of 63 patients were included. Multivariate analysis demonstrated that female gender (adjusted OR 0.04; 95% CI 0–0.84; p = 0.04) and combined technique (adj OR 0.001; 95% CI 0–0.81; p = 0.04) were predictors of worse outcome. Higher pc-ASPECTS (adj OR 4.75; 95% CI 1.33–16.94; p = 0.02) and higher Delta NIHSS (adj OR 2.06; 95% CI 1.16–3.65; p = 0.01) were predictors of better outcome. Delta NIHSS was the main predictor of good outcome at 90 days in patients with posterior circulation LVO presenting with NIHSS score ≤ 10.

Associations between Depression, Nutritional Status and Mediterranean Diet in Dalmatian Kidney Transplant Recipients.

Depression has been addressed as a predictor of worse outcomes in kidney transplant recipients (KTRs). Nutritional status plays a great role in treatment of this population. The Mediterranean diet (MeDi) has been associated with lower levels of depressive symptoms. The aim of this cross-sectional study was to determine the rate of depression and its correlations to nutritional status and dietary habits according to the MeDi in Dalmatian KTRs. We included 115 KTRs, and data about body composition and anthropometric, laboratory and clinical parameters were obtained for each study participant. The Beck Depression Inventory-II (BDI-II) questionnaire was used to assess depressive symptoms and the Mediterranean Diet Serving Score (MDSS) was used to assess adherence to the MeDi. We found the presence of depressive symptoms in 21.73% of the Dalmatian KTRs. BDI-II score was reciprocally associated with fat mass, trunk visceral fat, anthropometric parameters of obesity, triglyceride levels and olive oil consumption. Inverse associations were found between BDI-II score and skeletal muscle mass, handgrip strength, MCV, hemoglobin levels and consumption of fish and white meat, as suggested by the MeDi. Our results showed the interconnections between nutritional status, dietary habits and depression in Dalmatian KTRs.

Hyperuricemia as a prognostic marker for long-term outcomes in patients with myocardial infarction with nonobstructive coronary arteries

BackgroundHyperuricemia (HUA) has been proved as a predictor of worse outcomes in patients with coronary artery disease. Here, we investigated the prognostic value of HUA in a distinct population with myocardial infarction with nonobstructive coronary arteries (MINOCA).MethodsA total of 1179 MINOCA patients were enrolled and divided into HUA and non-HUA groups. HUA was defined as a serum uric acid level ≥ 420 μmol/L in men or ≥ 357 μmol/L in women. The primary study endpoint was a composite of major adverse cardiovascular events (MACE), including all-cause death, nonfatal MI, nonfatal stroke, revascularization, and hospitalization for unstable angina or heart failure. Kaplan–Meier, Cox regression, and receiver-operating characteristic analyses were performed.ResultsPatients with HUA (prevalence of 23.5%) had a significantly higher incidence of MACE (18.7% vs. 12.8%; p = 0.015) than patients without during the median follow-up of 41.7 months. HUA was closely associated with an increased risk of MACE even after multivariable adjustment (hazard ratio 1.498, 95% confidence interval: 1.080 to 2.077; p = 0.016). HUA remained a robust risk factor of MACE after propensity score matching analysis. Moreover, HUA showed an area under the curve (AUC) of 0.59 for predicting MACE. Incorporation of HUA to the thrombolysis in myocardial infarction (TIMI) score yielded a significant improvement in discrimination for MACE.ConclusionsHUA was independently associated with poor prognosis after MINOCA. Routine assessment of HUA may facilitate risk stratification in this specific population.

High Platelet Lymphocyte Ratio as Predictor of Bad Outcome in Patient with Acute Ischemic Stroke

Background/Aim: Stroke is a major cause of death and disability worldwide. Inflammatory markers for poor outcomes in stroke patients have been widely studied, but these examinations are often constrained by limited costs and facilities. Platelet lymphocyte ratio is one of the markers of inflammation that is easily examined, only a few researches were studied on stroke patients, especially ischemic type. This article aimed to understanding high platelet lymphocyte ratio as a risk factor for poor outcome in acute ischemic stroke patients. Method: The design of this research is literature review by literature from 32 journal and 5 textbooks. Journals obtained from search engines Pubmed, Google Scholar, and NCBI. Result: Based on the results of the literature review, circulating platelets play an important role in the development and resolution, not only because of their direct effect on the endothelium but also by releasing inflammatory mediators. Acute ischemic stroke will induce lymphocyte apoptosis, which causes impaired immune system. High platelet counts and low lymphocytes contribute to micro-thrombus formation, which increases the risk of stroke and has a poor prognosis in patient. Conclusion: There is an increase platelet lymphocyte ratio can be an independent predictor of poor outcome in acute ischemic stroke patient Keywords: acute ischemic, stroke, platelet lymphocyte ratio, poor outcome

Acute kidney injury in patients undergoing transcatheter aortic valve replacement: insights on clinical outcomes and prognostic factors

Abstract Acute Kidney Injury (AKI) after cardiac surgery is associated with increased mortality, but very few data exist on the occurrence of AKI associated with Transcatheter Aortic Valve Replacement (TAVR). The aim of this study was to determine the frequency and prognosis of AKI after transcatheter aortic valve replacement. Methods Between April 2008 and December 2019, 751 patients with severe aortic stenosis underwent to TAVR. The AKI was defined according to Valve set by the Academic Research Consortium, as the absolute increase in serum creatinine ≥0.3 mg/dl at 72 hours a percutaneous procedure. Results AKI was identified in 127 patients (16.9%) and 3 patients required renal replacement therapy. After implantation there was a slight improvement in renal function, baseline serum creatinine decreased from 1.37±0.9mg/dl to 1.22±0.6 mg/dl, p=0.01 and glomerular filtration rate (GFR) increased from 49.7±20 to 53.9±22, p&amp;lt;0.001. In patients with AKI, the mortality at 30 days was 12.6% compared to 1.3% of patients without AKI, [OR=11.08 (95% CI 4.631–26.514) p&amp;lt;0.001] and late mortality after a mean of 49.4±27 months, was 40.2% in those patients with AKI compared to 37.9% in those without AKI, [OR=1.101 (95% CI 0.730–1.662), p=0.360] In the multivariate analysis AKI was an independent predictor of cumulative total mortality [HR=1.644 (95% CI 1.230–2.198), p=0.001] and threatening bleeding [HR=3.623 (95% CI 1.448–8.764), p=0.004], but not cardiovascular mortality [HR=1.496 (95% CI 0,834.2.682), p=0.177]; readmission by heart failure [HR=1.249 (95% CI 0.652–2.392), p=0.502], myocardial infarction [HR=1.929 (95% CI 0.705–5.287), p=0.201]; or stroke [HR=1.662 (95% CI 0.874–3.142), p=0.118]. The predictors of AKI were: general anesthesia [HR=2.112 (1.038–4.246), p=0.039]; the first generation aortic prostheses [HR=3.485 (95% CI 2.211–5.442), p=0.001]; tricuspid regurgitation [HR=1.604 (95% CI 1.057–2.435), p=0.026] and renal chronic failure [HR=2.060 95% CI 1.148–3.699); p=0.015]. Conclusions Deterioration of renal function in patients undergoing TAVR is a serious and frequent complication. The occurrence of AKI was associated with increase early mortality and also was a predictor of worse outcomes throughout 3.65±2 years of follow-up. Funding Acknowledgement Type of funding sources: None.

High levels of psychosocial distress among Australian frontline healthcare workers during the COVID-19 pandemic: a cross-sectional survey

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has had a profound and prolonged impact on healthcare services and healthcare workers.AimsThe Australian COVID-19 Frontline Healthcare Workers Study aimed to investigate the severity...

Disease-Related Malnutrition and Sarcopenia Predict Worse Outcome in Medical Inpatients: A Cohort Study.

(1) Background: Both sarcopenia and disease-related malnutrition (DRM) are unfortunately underdiagnosed and undertreated in our Western hospitals, which could lead to worse clinical outcomes. Our objectives included to determine the impact of low muscle mass (MM) and strength, and also DRM and sarcopenia, on clinical outcomes (length of stay, death, readmissions at three months, and quality of life). (2) Methodology: Prospective cohort study in medical inpatients. On admission, MM and hand grip strength (HGS) were assessed. The Global Leadership Initiative on Malnutrition (GLIM) criteria were used to diagnose DRM and EWGSOP2 for sarcopenia. Assessment was repeated after one week and at discharge. Quality of life (EuroQoL-5D), length of stay (LoS), readmissions and mortality are reported. (3) Results: Two hundred medical inpatients, median 76.0 years-old and 68% with high comorbidity. 27.5% met GLIM criteria and 33% sarcopenia on admission, increasing to 38.1% and 52.3% on discharge. Both DRM and sarcopenia were associated with worse QoL. 6.5% died and 32% readmission in 3 months. The odds ratio (OR) of mortality for DRM was 4.36 and for sarcopenia 8.16. Readmissions were significantly associated with sarcopenia (OR = 2.25) but not with DRM. A higher HGS, but not MM, was related to better QoL, less readmissions (OR = 0.947) and lower mortality (OR = 0.848) after adjusting for age, sex, and comorbidity. (4) Conclusions: In medical inpatients, mostly polymorbid, both DRM but specially sarcopenia are associated with poorer quality of life, more readmissions, and higher mortality. Low HGS proved to be a stronger predictor of worse outcomes than MM.

Outcomes of Richter’s transformation of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL): an analysis of the SEER database

Richter's transformation (RT) is a rare complication arising in patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) and is associated with an overall dismal outcome. The rarity of this entity poses many challenges in understanding its biology and outcomes seen and the optimal treatment approach. We utilized the SEER (Surveillance, Epidemiology and End Results) database to identify patients diagnosed with CLL/SLL between 2000 and 2016 and subsequently had a diagnosis of diffuse large B-cell lymphoma (DLBCL) or Hodgkin lymphoma (HL), thus capturing those who experienced an RT event. We compared the outcomes of those patients to those of patients in the database diagnosed with DLBCL without a preceding CLL/SLL diagnosis. We identified 530 patients who developed RT out of 74,116 patients diagnosed with CLL/SLL in the specified period. The median age at RT diagnosis was 66years, and the median time from CLL/SLL diagnosis to RT development was roughly 4years. Patients with RT had a dismal outcome with median overall survival of 10months. We identified advanced Ann Arbor stage (III/IV) and prior treatment for CLL as predictors of worse outcome in patients with RT. Our study represents the largest dataset of patients with CLL/SLL and RT and adds to the existing literature indicating the poor outcomes for those patients.

Impact of COVID-19 lockdown on acute pediatric antipsychotic poisoning outcome in Tanta University Poison Control Centre

Background: Acute pediatric antipsychotic poisoning has obviously increased during COVID-19 lockdown. Minimal research concerning this topic were conducted in Egypt. Objectives: to identify the outcome predictors of acute pediatric antipsychotics poisoning during COVID 19 lockdown. Methods: The study was carried on children with acute antipsychotics poisoning admitted to Tanta University Poison Control center from (2019-2020). Recorded data were obtained from patients‟ files including sociodemographic characteristics, clinical examination, results of laboratory investigations, and ECG in addition to severity assessment by poison severity score. Results: A noticeable increase in the overall number of antipsychotic poisoned children was observed in 2020 than 2019. Additionally, the ingested doses, suicidal rates and the mean delay time were increased in 2020. Lower GCS ranging from 3-8 and 9-12 were more observed in 2020 compared to 2019. Atypical agents with minimal extrapyramidal manifestations were more commonly ingested. Hypotension and ECG changes particularly sinus tachycardia and prolonged QTc intervals were common in the studied sample and observed frequently in 2020 than 2019 cases. ICU admission rate together with hemodynamic instability increased in 2020 than that in 2019 however the length of hospital stay was nearly equal. Logistic regression analysis revealed that lower GCS and higher PSS were significantly accompanied by increased the likelihood of ICU admission. Conclusion: Severity of antipsychotic poisoning was higher during COVID-19 lockdown. Predictors of worse outcomes regarding ICU admission rates, neurological and cardiovascular toxicities were concluded.

Abstract 357: Cancer associated macrophage like cells predict aggressive disease in local and metastatic prostate cancers

Abstract Background: Prostate cancers (PC) are intrinsically complex, with few prognostic biomarkers that differentiate aggressive and indolent disease. Cancer associated macrophage like cells (CAMLs) have shown to be significant independent prognostic indicators for poor survival in tumors if engorged to ≥50μm. However, no group has examined CAMLs' in PC. In this prospective pilot study, we analyzed PSA &amp; ≥50μm CAML presence in (n=51) Stage I-III &amp; (n=41) metastatic PC (mPC) prior to the start of new treatments to examine CAMLs' on outcomes. We found that ≥50μm CAML presence significantly predicted worse patient survival in mPC. These preliminary results suggest that CAMLs may serve as a cheap, non-invasive prognostic biomarker that predicts for worse outcomes in both local &amp; mPC prior to new therapies. Methods: We prospectively recruited (n=92) PC patients in this pilot study to examine CAML's prognostic significance in non-metastatic (stages I-III) and mPC. Of (n=92) total patients, 15% (n=14/92) were stage I, 32% (n=29/92) stage II, 9% (n=8/92) stage III, and 45% (n=41/92) Stage IV. Prior to the induction of new therapy or first line therapy for newly diagnosed patients, 7.5mL peripheral baseline (BL) blood was collected. Blood was filtered via CellSieveTM microfiltration, which excludes cells by size ≥7μm. In parallel, changes in PSA was monitored to compare prognostic significance against ≥50μm CAMLs. Wilcoxon univariate analysis was used to analyze ≥50μm CAMLs and PSA in progression free survival (PFS) and overall survival (OS). Results: CAML's were identified in 78.9% (n=71/90) of available BL samples, with two samples failing from clotting. Stage I-III patients had an average of ~3 CAMLs/7.5mL blood, whereas mPCs contained ~6 CAMLs/7.5mL. Average CAML size increased linearly with advancing stage of disease with stage I patients averaging 23μm, stage II 33μm, stage III 65μm, and stage IV 78μm. Of available BL samples, 41% (n=38/90) patients with ≥50μm CAMLs significantly predicted for worse PFS (HR=10.0, p&amp;lt;0.001, 95%CI=0.07-0.31) and OS (HR=34.2, p&amp;lt;0.001, 95%CI=0.03-0.21). Further, ≥50μm CAMLs significantly predicted for poorer survival in mPC with PFS (HR=9.4, p=0.028, 95%CI=0.18-0.84) and OS (HR=5.1, p=0.003, 95%CI=0.07-0.53), but only non-significantly trended in non-metastatic disease. Initial analysis of PSA found that high PSA at BL was a significant predictor for worse outcomes in patients, while changes in PSA was not a predictor. Conclusions: CAMLs have shown potential as a predictive non-invasive blood based biomarker across multiple solid malignancies, and here we compared this biomarker in PC. While preliminary, these data suggests that engorged CAML presence prior to the start of new treatment may be a statistically significant predictor of survival in both the local and metastatic setting, and a larger validation cohort should be established. Citation Format: Daniel J. Gironda, Raymond Bergan, R K. Alpaugh, Daniel C. Danila, Tuan L. Chuang, Brenda Y. Hurtado, Thai Ho, Cha-Mei Tang, Daniel L. Adams. Cancer associated macrophage like cells predict aggressive disease in local and metastatic prostate cancers [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 357.

Long-term outcomes of percutaneous coronary interventions within coronary artery bypass grafts.

IntroductionThe long-term outcomes of percutaneous coronary interventions (PCIs) within coronary artery bypasses are still poor as compared to those within native coronary arteries. Thus, we aimed to assess predictors of long-term clinical outcomes after PCIs of coronary bypasses.Material and methodsWe enrolled 194 patients after PCIs of coronary artery bypasses at the mean age of 69.5 ±8.3 years (73.2% male). The primary study endpoint was a combination of target-vessel revascularization (TVR), target-lesion revascularization (TLR), myocardial infarction (MI), stroke, coronary artery bypass grafting (CABG) and death. The mean follow-up was 964 ±799.1 days and was completed among 156 patients. Multivariate analysis was used to assess determinants of study endpoints during follow-up. Moreover, we compared survival curves according to the type of PCI and presence of anti-embolic protection.ResultsThe primary endpoint of the study occurred in 59.7% of patients after the mean time of 669.6 ±598.7 days. The TVR occurred in 37.9% of individuals, TLR in 24.2%, MI in 26.3%, stroke in 4.2%, CABG in 2.1% and death in 30.5% of patients. In Cox multivariate analysis, PCI of two or more bypasses (p < 0.01), post-dilatation (p < 0.05) and no-reflow (p < 0.05) were the independent determinants of the primary study endpoint. No significant impact of anti-embolic protection devices on long-term outcomes was observed.ConclusionsPercutaneous coronary interventions of two or more bypasses, post-dilatation and no-reflow are predictors of worse outcome in patients undergoing PCI within coronary artery bypass grafts.

Does the Age Affect the Outcomes of Cardiac Resynchronization Therapy in Elderly Patients?

Background: More and more heart failure (HF) patients aged ≥ 75 years undergo cardiac resynchronization therapy (CRT) device implantation, however the data regarding the outcomes and their predictors are scant. We investigated the mid- to long-term outcomes and their predictors in CRT patients aged ≥ 75 years. Methods: Patients in the Cardiac Resynchronization Therapy Modular (CRT MORE) Registry were divided into three age-groups: <65 (group A), 65–74 (group B) and ≥75 years (group C). Mortality, hospitalization, and composite event rate were evaluated at 1 year and during long-term follow-up. Results: Patients (n = 934) were distributed as follows: group A 242; group B 347; group C 345. On 12-month follow-up examination, 63% of patients ≥ 75 years displayed a positive clinical response. Mortality was significantly higher in patients ≥ 75 years than in the other two groups, although the rate of hospitalizations for HF worsening was similar to that of patients aged 65–74 (7 vs. 9.5%, respectively; p = 0.15). Independent predictors of death and of negative clinical response were age >80 years, chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD). Over long-term follow-up (1020 days (IQR 680-1362)) mortality was higher in patients ≥ 75 years than in the other two groups. Hospitalization and composite event rates were similar in patients ≥ 75 years and those aged 65–74 (9 vs. 11.8%; p = 0.26, and 26.7 vs. 20.5%; p = 0.06). Conclusion: Positive clinical response and hospitalization rates do not differ between CRT recipients ≥ 75 years and those aged 65–74. However, age > 80 years, COPD and CKD are predictors of worse outcomes.

Распространенность и прогностическое значение поражения печени при хронической сердечной недостаточности

Heart failure (HF) is characterized by systemic hemodynamicchanges that negatively affect all organs, including liver.Large-scale clinical trials, which involved mostly patients withheart failure and reduced ejection fraction, showed the highprevalence of abnormal liver function tests that had poorprognosis. Patients with common comorbidities, such as obesity, diabetes mellitus, and arterial hypertension, frequentlypresent with both non-alcoholic fatty liver disease (NAFLD)and subclinical HF. The association between these two conditions, both leading to hepatic injury, was shown in severalstudies. The criteria for non-invasive diagnosis of cardiogenicliver damage, including fibrosis, are not established. Studiessuggested the correlation between liver stiffness measured byelastography and liver function test abnormalities in patientswith decompensated HF. Moreover, liver stiffness was a predictor of worse outcomes. However, liver stiffness thresholdsare not defined for patients with HF. The interpretation ofliver function test alterations in HF also remains ambiguous,and there is no unified classification of hepatic injury in HF.The role of NAFLD in patients with symptomatic HF is not wellunderstood and requires future research.

Abstract P4: Predictors of Outcomes in Patients With Mild Ischemic Stroke Symptoms: Results From the Mild and Rapidly Improving Stroke Study (mariss)

Background: Although most strokes present with mild symptoms, these have been poorly represented in clinical trials. The objective is to describe multidimensional outcomes, identify predictors of worse outcomes and explore the effect of thrombolysis in this population. Methods: This prospective observational study included patients with ischemic stroke or TIA presenting with stroke symptoms and a baseline NIHSS 0-5 within 4.5 hours from symptom onset. The primary outcome was a 90-day modified Rankin Scale (mRS) 0-1; secondary outcomes included good outcomes in the Barthel Index, Stroke Impact Scale-16 (SIS-16) and European Quality of Life. Multivariable models were created to determine predictors of outcomes and the effect of alteplase. Results: A total of 1765 participants were included from 100 Get With The Guidelines (GWTG)-Stroke participating hospitals (age 65 + 14, 42% women, final diagnosis ischemic stroke 90%, TIA 10%, 57% received alteplase). At 90 days, 37% were disabled and 25% not independent. Worse outcomes were noted for older individuals, women, non-Hispanic Blacks and Hispanics, Medicaid, smokers, those with diabetes, atrial fibrillation, prior stroke, higher baseline NIHSS, visual field defects, arm and leg weakness. Similar outcomes were noted for the alteplase-treated and the untreated groups. Alteplase treated patients were younger (64 + 13 vs. 67 + 1.4) with a higher NIHSS (2.9 + 1.4 vs. 1.7 + 1.4). After adjusting for age, sex, race-ethnicity, and baseline NIHSS, we did not identify an effect of alteplase on the primary outcome but did find an effect on SIS-16 in the restricted sample of baseline NIHSS 3-5. Very few symptomatic hemorrhages were recorded (3/999). Conclusions: A large proportion of stroke patients presenting with a low NIHSS have a disabled outcome. Baseline predictors of worse outcomes are described. An effect of alteplase on outcomes was not identified in the overall cohort but an indication of efficacy was noted in the NIHSS 3-5 subgroup.

Abstract MP12: Drivers of Rescue Therapy Efficacy for Vasospasm Following Aneurysmal Subarachnoid Hemorrhage: A Propensity-Score Matched Analysis With Machine Learning

Introduction: One of the foremost challenges in subarachnoid hemorrhage (SAH) management is understanding which patient characteristics and treatment decisions lead to good outcomes. This study uses novel game theory-based methods in explainable machine learning (ML) and propensity-score matching to elucidate the clinical factors driving outcomes following rescue therapy for post-SAH vasospasm. Methods: Data for patients with post-SAH angiographic or symptomatic vasospasm were obtained from six clinical trials and observational studies in the Subarachnoid Hemorrhage International Trialists (SAHIT) repository. Gradient boosting ML models were constructed for each patient to predict the probability of receiving rescue therapy and 3-month Glasgow Outcome Scale (GOS) scores. Shapley Additive Explanation (SHAP) values were calculated to quantify feature importance and interaction effects. Variables with high SHAP importance in predicting rescue therapy were used in a propensity score-matched analysis of rescue therapy and 3-month GOS scores. Results: A total of 1,532 patients were included. SAH characteristics and neurological sequelae, but not admission neurological scores, heavily influenced the probability of receiving rescue therapy. Comparing feature importances showed cerebral ischemia/infarction was invariably linked to poor outcome, while other important predictors of outcome varied by rescue type. Higher blood pressures and fewer postoperative days until vasospasm treatment were more important for predicting worse outcome following interventional rescue, while high admission WFNS grade and pneumonia were important predictors of worse outcome for non-interventional rescue. Finally, in a propensity score-matched analysis guided by SHAP-based variable selection, rescue therapy was associated with higher odds of 3-month GOS of 4-5 (odds ratio: 1.63; 95%CI 1.22-2.17; p=0.001). Conclusion: Rescue therapy for vasospasm was associated with good functional outcomes. Future randomized trials focusing on preventative or therapeutic interventions may be able to demonstrate improvements in clinical outcomes. Insights from these models may help improve patient selection criteria and trial designs for rescue therapy.