Predictors Of Clinical Success Research Articles

Impact of hypoalbuminemia on clinical outcomes among patients with obesity treated with ceftriaxone.

The use of ceftriaxone, a highly protein-bound drug, in the setting of hypoalbuminemia may result in suboptimal drug exposure. Patients with obesity also exhibit higher absolute drug clearance. We aimed to evaluate the impact of hypoalbuminemia on clinical success among hospitalized adults with obesity who were treated with ceftriaxone. This retrospective review included adult inpatients with weight >100 kg or body mass index >40 kg/m2 who received ceftriaxone 2 g intravenously every 12 hours for at least 72 hours. The primary outcome was clinical success, a composite of clinical cure and microbiologic cure. Secondary outcomes included clinical cure, microbiologic cure, length of stay, ICU length of stay, mortality, 30-day readmission, and adverse events. In all, 137 patients were included, 34 of whom had a serum albumin of ≤2.5 g/dL. In a propensity-score-weighted analysis, clinical success was significantly more common among those without hypoalbuminemia (91.2%) as compared to those with hypoalbuminemia (77.8%) (P = 0.038). Death within 30 days (13.7% vs 0%, P < 0.001) and 30-day readmission (31.6% vs 12.0%, P = 0.008) were more common in the hypoalbuminemia group. In a univariate analysis, serum albumin and indication for ceftriaxone use were found to be predictors of clinical success. Hypoalbuminemia was associated with a lower rate of clinical success among patients with obesity who were treated with ceftriaxone 2 g every 12 hours.

Long-term success rates of a stable, low pressure cryo balloon for the treatment of paroxysmal atrial fibrillation - results of the prospective, international, multicenter POLAR-ICE study

Abstract Background/Introduction Pulmonary vein isolation (PVI) using a cryo balloon is well-established for the treatment of paroxysmal atrial fibrillation (PAF). Compared to other available technologies, the usage of a stable, low pressure cryo balloon (POLARx, Boston Scientific) has demonstrated lower nadir temperatures and longer thawing times. However, long term efficacy and safety still needs to be proven. Purpose The aim of the POLAR-ICE Study was to evaluate long-term efficacy and safety outcome of cryo balloon ablation in patients with paroxysmal atrial fibrillation. Methods POLAR ICE, a prospective, non-randomized, international, multicenter study, enrolled 399 patients across 19 centers, between Aug 2020 and May 2021. Patients with paroxysmal atrial fibrillation undergoing de novo PVI were included into the study. During the index procedure, procedural characteristics, such as time to isolation (TTI), cryoablations per pulmonary vein, balloon nadir temperature, and occlusion grade were recorded. Procedural success was defined as successful isolation of each vein proven by entrance block. Follow up visits were at 3, 6, and 12 months. Recurrence is defined as any documented (ECG/Holter) episode of atrial fibrillation / atrial tachycardia longer than 30sec. after a blanking period of 3 months. Results 399 patients (mean age 61 years, 36% female) were included into the study. After 12 months, freedom from any arrhythmia was 83.5% and freedom from atrial fibrillation 88.1% (Figure 1). Procedure/ablation related Serious adverse events occurred in 8.7% of patients, and included access complications (2.6%), cardiac tamponade (0.5%), air embolism (0.3%), AV block (0.3%), effusion (0.3%) phrenic nerve palsy (0.3%), stroke (0.3%), transient ischemic attack (0.3%). Redo procedures have been conducted in 19 patients. In 14/19 pts reconnection of at least one PV could be identified (RSPV n=8, RIPV n=12, LSPV n=9, LIPV n=11). Freedom from any arrhythmia was associated with lower nadir temperature (p=0.008) and longer time to thaw (p=0.05) during the index procedure. Conclusions In this prospective, non-randomized, international, multicenter study, isolation of the pulmonary veins using a stable, low pressure cryo balloon was highly effective and safe in patients treated for paroxysmal atrial fibrillation. Lower nadir temperatures and a longer thawing time were predictors of clinical success.

Blunt Trauma in Children: Efficacy and Safety of Transarterial Embolization, 10-Year Experiences in a Single Trauma Center.

Transcatheter arterial embolization (TAE) is an established approach for controlling hemorrhage in adults with acute abdominal and pelvic trauma. However, its application in pediatric trauma is not well established. This study aimed to evaluate the safety and effectiveness of TAE in a population of pediatric patients with blunt trauma. This retrospective study was conducted in pediatric patients (<18 years) who underwent TAE for blunt trauma between February 2014 and July 2022. The patients were categorized into subgroups based on age and body weight. Patient demographics, injury severity, transfusion requirements, and clinical outcomes were analyzed. Exactly 73 patients underwent TAE. Technical success was achieved in all patients (100%), and clinical success was achieved in 83.6%. The mortality and complication rates were 4.1% and 1.4%, respectively. The mean duration of hospitalization was 19.3 days. Subgroup analysis showed that age, body weight, and sex did not significantly affect clinical success. The injury severity score and transfusion requirement were predictors of clinical success, with lower values associated with better outcomes. TAE is effective and safe for managing blunt pediatric trauma in younger and lighter patients. Injury severity and transfusion requirement are predictors of clinical success.

Predictors of clinical success after transcatheter paravalvular leak closure: An international prospective multicenter registry

Predictors of clinical success after transcatheter paravalvular leak closure: An international prospective multicenter registry

Transcatheter arterial embolization for cancer-related non-variceal upper gastrointestinal bleeding: A multicenter retrospective study of 107 patients

PurposeThe purpose of this study was to retrospectively evaluate the outcome of transcatheter arterial embolization (TAE) in the treatment of cancer-related non-variceal upper gastrointestinal bleeding (UGIB). Materials and methodsOne-hundred and seven patients who underwent TAE for the treatment of cancer-related non-variceal UGIB at five institutions between June 2016 and May 2019 were retrospectively included. There were 78 men and 29 women, with a mean age of 60.6 ± 13.2 (SD) (age range: 31–87 years). Clinical success was defined as no rebleeding within 30 days after TAE. Rebleeding was defined as non-variceal UGIB resulting in a decrease in hemoglobin > 2 g/dL within 24 h. The Kaplan-Meier method was used to estimate actuarial probabilities of rebleeding and survival within 30 days after TAE. Univariable and multivariable analyses were performed to identify variables associated with clinical success and 30-day mortality. ResultsTechnical success was achieved in 106 out of 107 patients (99.1%). Positive angiographic findings (contrast extravasation and pseudoaneurysm) were observed in 30/107 patients (28.0%). Empiric embolization was performed in 77/107 patients (72.0%). Clinical success was achieved in 60/107 patients (56.1%). The 3-day, 7-day, and 30-day actuarial probabilities of rebleeding were 21.5%, 31.0%, and 44.6%, respectively. No variables were identified as predictors of clinical success. Nineteen patients (19/107; 17.8%) died within 30 days after TAE; of them, 14 (14/107; 13.1%) died due to bleeding-related causes. The 3-day, 7-day, and 30-day actuarial probabilities of survival were 91.6%, 88.8%, and 77.4%, respectively. A baseline hemoglobin level of ≤ 60 g/L (Odds ratio [OR]: 3.376; 95% confidence interval [CI]: 1.223–9.318; P = 0.019) and clinical failure (OR: 6.149; 95% CI: 2.113–17.893; P = 0.001) were identified as predictors of 30-day mortality. Major complications (gastrointestinal perforation) occurred in one patient (1/107; 0.9%). Minor complications (abdominal pain, fever, and vomiting) occurred in 19 patients (19/107; 17.8%). ConclusionTAE is a safe treatment option for patients with cancer-related non-variceal UGIB, and seems to be effective in more than half of these patients.

PB2285: CLINICAL EXPERIENCE WITH CEFTAZIDIME-AVIBACTAM FOR THE TREATMENT OF BACTEREMIA DUE TO CARBAPENEM-RESISTANT GRAM-NEGATIVE BACTERIA IN HEMATOLOGIC PATIENTS

Background: Experience on effectiveness of ceftazidime-avibactam (CAZ-AVI) for bacteremia caused by carbapenem-resistant gram-negative bacteria in hematologic patients is scare. Aims: We conducted this cohort to evaluate the effectiveness and safety of CAZ-AVI for this population, and also, to explore the predictors of clinical outcome. Methods: We performed a retrospective, observational study at a blood diseases hospital in China for patients who received ≥ 72 h of CAZ-AVI for bloodstream infections due to carbapenem-resistant Enterobacteriacea and Pseudomonas aeruginosa between November 2018 and June 2021. Clinical and microbiological characteristics of these patients were collected; clinical and microbiological outcomes, occurrence of adverse effect were assessed. We compared the survival between transplant and nontransplant patients, also between patients who did or did not undergo granulocyte recovery within 14 days. We used Kaplan-Meier survival estimates to generate survival curves. To identify predictors of survival and clinical success, univariate and multivariate analysis was performed. Results: Forty-seven patients were eligible for our study. Forty (85.1%) patients received combination therapy, while seven received CAZ-AVI monotherapy. All patients infected with MBL (metallo-β-lactamase)-CRE (carbapenem-resistant Enterobacteriaceae) (n=23) received combination therapy with aztreonam. The survival at 28 days was 83.0% in 47 patients, and was 91.3% (21/23) in patients with MBL-CRE bacteremia. Clinical success was observed in 35/47 (74.5%) patients. Multivariate analysis revealed the most significant factor of clinical success was the granulocyte recovery within 14 days. Summary/Conclusion: CAZ-AVI-containing regimen is an effective option for the bacteremia due to carbapenem-resistant Gram-negative bacteria among hematologic patients, even in those infected with MBL-CRE bacteremia. Appropriate combination therapy is important after acquiring the information of enzymes and susceptibility to CAZ-AVI in vitro. Granulocyte recovery within 14 days may be a predictor of clinical success.

Outcome-Based Decision-Making Algorithm for Treating Patients with Primary Aldosteronism.

BackgroundOptimal management of primary aldosteronism (PA) is crucial due to the increased risk of cardiovascular and cerebrovascular diseases. Adrenal venous sampling (AVS) is the gold standard method for determining subtype but is technically challenging and invasive. Some PA patients do not benefit clinically from surgery. We sought to develop an algorithm to improve decision-making before engaging in AVS and surgery in clinical practice.MethodsWe conducted the ongoing Korean Primary Aldosteronism Study at two tertiary centers. Study A involved PA patients with successful catheterization and a unilateral nodule on computed tomography and aimed to predict unilateral aldosterone-producing adenoma (n=367). Study B involved similar patients who underwent adrenalectomy and aimed to predict postoperative outcome (n=330). In study A, we implemented important feature selection using the least absolute shrinkage and selection operator regression.ResultsWe developed a unilateral PA prediction model using logistic regression analysis: lowest serum potassium level ≤3.4 mEq/L, aldosterone-to-renin ratio ≥150, plasma aldosterone concentration ≥30 ng/mL, and body mass index <25 kg/m2 (area under the curve, 0.819; 95% confidence interval, 0.774 to 0.865; sensitivity, 97.6%; specificity, 25.5%). In study B, we identified female, hypertension duration <5 years, anti-hypertension medication <2.5 daily defined dose, and the absence of coronary artery disease as predictors of clinical success, using stepwise logistic regression models (sensitivity, 94.2%; specificity, 49.3%). We validated our algorithm in the independent validation dataset (n=53).ConclusionWe propose this new outcome-driven diagnostic algorithm, simultaneously considering unilateral aldosterone excess and clinical surgical benefits in PA patients.

The use of oocyte cryopreservation for fertility preservation in patients with sex chromosome disorders: a case series describing outcomes.

Characterize outcomes among adolescents and young adults (AYAs) with sex chromosome disorders (SCDs) after oocyte cryopreservation (OC) consultation. Retrospective case series of all AYA (< 25years) patients with SCDs seen for OC consultation from 2011 to 2019 at a large, urban, academic fertility center. All AYA patients with an SCD seen for OC consult in the study time period were reviewed and included. Data collected included patient age, SCD type, number of patients who attempted OC, number of cycles attempted, and cycle outcomes. Twenty-two patients were included: 9 with Turner syndrome, 12 with mosaic Turner syndrome, and 1 with 47,XXX. Mean age at consult was 14.7 ± 3.5years. Fourteen patients elected for OC: 5 with Turner syndrome, 8 with mosaic Turner syndrome, and 1 47,XXX who pursued 31 OC cycles total. Of those 14 patients, 10 underwent retrieval, 9 froze oocytes, and 8 froze mature (MII) oocytes. Seven patients underwent > 1 cycle and 7 had ≥ 1 cancelation. 3/3 patients who pursued cycles after 1st cancelation never got to retrieval. Age, SCD type, and baseline FSH did not predict ability to freeze MIIs. One patient returned after OC and attempted 4 ovulation induction cycles and 2 IVF cycles; all were canceled for low response. AYA patients with SCDs have a high risk of poor response and cycle cancelation but the majority froze MIIs. Thus, setting expectations is important. A larger sample size is needed to evaluate possible clinical predictors of success.

1288. Evaluation of Predictors for Clinical Success in Patients Treated with Eravacycline for Various Infections

Abstract Background Eravacycline (ERV) is approved in the United States (US) for the treatment of complicated intra-abdominal infections in adults. We aimed to evaluate the independent predictors of clinical success in patients treated with ERV for various infections. Methods Multicenter, retrospective, observational study conducted from September, 2018 to April, 2021. We included adults treated with ERV for ≥ 72hours. Clinical success was defined as 30-day survival, lack of 30-day infection-recurrence, and resolution of infection signs/symptoms. All outcomes were measured from ERV initiation. Multivariable logistic regression (MLR) was performed to identify independent predictors of clinical success. Clinically relevant variables were selected for model entry based on bivariate comparisons (P&amp;lt; 0.2) in a backward fashion. Results We included 223 patients from 16 medical centers in 13 geographically unique states. The median (IQR) age was 61 (50-69) years, 57% were male and 62% were Caucasian. Median (IQR) APACHE II, and Charlson Comorbidity scores were 15 (10-21), and 3 (1-5), respectively. Sources of infection were primarily intra-abdominal (27%) and respiratory (27%). Common pathogens included Acinetobacter baumannii (21%) and those of the Enterobacterales order (36%). Infectious diseases consultation and surgical interventions were obtained in 93.7% and 52% respectively. Clinical success occurred in 64%, specifically 30-day survival in 78%, absence of 30-day infection-recurrence in 93%, and 74% experienced resolution of infection signs/symptoms. Since characteristics and outcomes were similar among various pathogens, MLR was conducted using the overall cohort. Skin as a source and combination therapy with ERV were independently associated with higher clinical success: odds ratio 3.3 [CI 1.1-10.2] and 2.9 [1.4-5.9], respectively. Whereas, ICU admission at culture time and undergoing surgery within 30 days of culture were independently associated with reduced odds of clinical success: 0.4 [0.17-0.80] and 0.3 [0.11-0.63] respectively. Conclusion Although most ERV treated patients experienced clinical success, factors independently associated with higher clinical success are crucial to consider for optimum antibiotic selection. Disclosures Kimberly C. Claeys, PharmD, GenMark (Speaker’s Bureau) Madeline King, PharmD, tetraphase (Speaker’s Bureau) Michael P. Veve, Pharm.D., Cumberland (Grant/Research Support)Paratek Pharmaceuticals (Research Grant or Support) Bruce M. Jones, PharmD, BCPS, Abbvie (Consultant, Advisor or Review Panel member, Speaker’s Bureau)La Jolla (Speaker’s Bureau)Melinta (Consultant)Merck (Consultant)Paratek (Consultant, Speaker’s Bureau) Susan L. Davis, PharmD, Nothing to disclose Michael J. Rybak, PharmD, MPH, PhD, Paratek Pharmaceuticals (Research Grant or Support)

B-PO03-054 OUTCOMES OF TRANSVENOUS LEAD EXTRACTION USING THE TIGHTRAILTM MECHANICAL ROTATING DILATOR SHEATH

The TightRailTM is a mechanical rotating dilator sheath widely used in transvenous lead extraction (TLE). Approved in 2014, there remains limited data on procedural outcomes. To describe outcomes of TLE using TightRailTM and predictors of clinical success. Patients undergoing TLE with leads targeted using the TightRailTM as the first and (if required) second tool were identified from a single center prospective registry (2013-2019). Clinical success was defined as lead removal with residual fragments, if any, <4 cm not impacting procedural goals. Lead and patient characteristics associated with successful extraction were analyzed. 189 leads (124 patients) were included. Mean lead age was 12.6 years (+/- 7.9 years) with 59 ICD leads (38 dual coil). Success with first TightRailTM use was 59% (114/189). 46/75 remaining leads were targeted with TightRailTM as the second tool. In this group, success rate rose to 91.1% (144/158). For the remaining 14 leads, 11 were successfully extracted (5 - TightRailTM, 6 - other tools) resulting in overall clinical success in this cohort of 98% (155/158). Lead age > 10 years and dual coil ICD lead were associated with lower success rate with the first TightRailTM use on a target lead. There were 3 adverse events including 1 death (sepsis complications) and 2 SVC tears, both with high-risk features including lead dwell >30 years with SVC occlusion in one patient and lead dwell >12 years with dual coil ICD lead in the other. In this series, which to our knowledge is the largest to date, the TightRailTM is an effective tool for transvenous lead extraction. Further evaluation in prospective studies is warranted.

Ustekinumab for Perianal Crohn's Disease: The BioLAP Multicenter Study From the GETAID.

New therapeutic options for patients with Crohn's disease (CD) with perianal lesions failing anti-tumor necrosis factor (TNF) agents are needed. We aimed to assess the effectiveness of ustekinumab in perianal CD (pCD) and predictors of clinical success in a real-life multicenter cohort. We conducted a national multicenter retrospective cohort study in patients with either active or inactive pCD who received ustekinumab. In patients with active pCD at treatment initiation, the success of ustekinumab was defined by clinical success at 6 months assessed by the physician's judgment without additional medical or surgical treatment for pCD. Univariate and multivariable logistic regression analyses were performed to identify predictors of success. In patients with inactive pCD at ustekinumab initiation, the pCD recurrence-free survival was calculated using the Kaplan-Meier method. Two hundred seven patients were included, the mean age was 37.7 years, the mean duration of CD was 14.3 years, and the mean number of prior perianal surgeries was 2.8. Two hundred five (99%) patients had previously been exposed to at least 1 anti-TNF and 58 (28%) to vedolizumab. The median follow-up time was 48 weeks; 56/207 (27%) patients discontinued therapy after a median time of 43 weeks. In patients with active pCD, success was reached in 57/148 (38.5%) patients. Among patients with setons at initiation, 29/88 (33%) had a successful removal. The absence of optimization was associated with treatment success (P = 0.044, odds ratio 2.74; 95% confidence interval: 0.96-7.82). In multivariable analysis, the number of prior anti-TNF agents (≥3) was borderline significant (P = 0.056, odds ratio 0.4; 95% confidence interval: 0.15-1.08). In patients with inactive pCD at initiation, the probability of recurrence-free survival was 86.2% and 75.1% at weeks 26 and 52, respectively. Ustekinumab appears as a potential effective therapeutic option in perianal refractory CD. Further prospective studies are warranted.

Reduced patency in left-sided arteriovenous grafts

For decades, arteriovenous access grafts for hemodialysis have been saddled with poor long-term utility and few clinical predictors of success. Traditionally, sidedness of access creation has been based on extremity dominance, ignoring any possible contribution of laterality to patency. The novel hypothesis that laterality might play a role in the patency of arteriovenous grafts was tested in this thoughtful preclinical study.

Role of Bacterial and Fungal Epidemiological Cutoff Values for Antimicrobial Susceptibility Testing in the Microbiology Laboratory

Epidemiological cutoff values (ECVs) are increasingly used in clinical microbiology and public health laboratories. Breakpoint-setting organizations have developed ECVs for bacteria and fungi. ECVs separate organism populations into wild type (WT) and non-wild type (NWT) and are defined according to species. They differ from clinical breakpoints in that clinical outcome and pharmacokinetic/pharmacodynamic data are not taken into account during their development. Thus, ECVs are not predictors of clinical success (or failure) in the patient. Laboratories should never report WT organisms as “susceptible” or NWT organisms as “resistant.” Microbiologists must be aware of the limitations and differences of ECVs as compared to breakpoints, and if ECVs are applied for individual patient care, discussions between the microbiology laboratory and other key health care providers should take place. Clinical report comments aid in interpretation of ECVs.

Acute and early EUS-guided transmural drainage of symptomatic postoperative fluid collections

EUS-guided postoperative drainage (EUS-POD) of postoperative fluid collections (POFCs) is typically delayed until a thick wall has formed to optimize safety. Thus, percutaneous drainage is the mainstay of early POFC management. The primary aim of this study was to compare technical and clinical success and adverse event (AE) rate between early (0-30 days postoperative) compared with delayed (>30 days) EUS-POD. The secondary aim was to determine predictors for clinical success and AE rate associated with early compared with delayed EUS-POD. This was a retrospective analysis of consecutive patients undergoing EUS-POD between November 2013 and November 2018 at a single tertiary academic center. Demographic, procedural, and outcomes data were recorded. Clinical success was defined as resolution of symptoms and the fluid collection on cross-sectional imaging without recurrence after transluminal stent removal. Seventy-five patients underwent EUS-POD; 42 (56%) were early, of whom 20 were acute. Sixty-three patients (84%) had undergone distal pancreatectomy. Technical success was 100%, and clinical success was achieved in 70 patients (93%) after a mean 2.2 procedures (range, 1-5). Prior percutaneous drainage had been performed in 13 patients (17.3%). Both acute and early drainage versus delayed EUS-POD demonstrated similar rates of clinical success (95% and 93% vs 94%, P= .99) and AEs (21.4% and 15% vs 30.3%, P= .43). Necrosectomy was required less often in the early versus the delayed group. No predictors of clinical success were identified. Early EUS-POD was not a predictor of AEs (P= .65). Infection and collection size >10 cm correlated with increased AE risk (P=.048 and .007, respectively). Early and even acute EUS-POD of POFCs appears to be technically feasible, clinically effective, andsafe. EUS-POD should be considered for definitive management of early symptomatic POFCs.

887 Clinical Efficacy of Endoscopic Vacuum-Assisted Closure Therapy (EVAC) in Gastroesophageal Defects: A Systematic Review and Comparative Meta-Analysis With Endoscopic Stent Therapy (EST)

INTRODUCTION: Treatment of gastroesophageal leaks and perforations after upper gastrointestinal surgery remains clinically challenging. Advanced endoscopic interventions have traditionally included placement of self-expanding metal or plastic stents i.e. endoscopic stent therapy (EST) and endoscopic vacuum-assisted closure therapy (EVAC). The aim of our study was to evaluate the overall clinical efficacy of EVAC when compared to EST in the treatment of gastroesophageal defects. METHODS: Our primary goals were to analyze the pooled rates of clinical success and overall mortality with EVAC therapy in gastroesophageal defects. Using EST as a comparator group, we analyzed clinical outcomes and predictors of clinical success. RESULTS: 6 cohort studies compared EVAC (109 patients) to EST (197 patients). These included 313 cases of esophageal anastomotic leaks. The pooled odds ratio of clinical success with EVAC was 2.9 (95% CI 1.4-5.8, P = 0.003, I2 = 13) when compared to EST in the treatment of esophageal leaks secondary to surgical anastomosis. The pooled odds ratio of mortality was 0.43 (95% CI 0.19-0.95, P = 0.04, I2 = 0). When all studies that evaluated EVAC alone were analyzed (14 studies - 89 perforations and 136 anastomotic leaks), the pooled rate of clinical success was 87.5% (95% CI 81.6-91.7, I2 = 0, P = 0.001). For studies evaluating EST (12 studies, 349 patients), the pooled rate of clinical success was 75.4% (95% CI 75.6-84.1, P = 0.001, I2 = 30). EVAC performed significantly better than EST (P = 0.004). The pooled mortality rate with EVAC was 9.1% (95% CI 4.5-17.5, P = 0.01, I2 = 0) and with EST was 17.2% (95% CI 11.2-20.2, P = 0.001, I2 = 38). Based on univariate meta-regression analysis, anastomotic leaks demonstrated statistical significance as a predictive factor of clinical success with EVAC (2-sided P-value 0.05, R2 analog = 1), whereas perforation almost reached statistical significance (2-sided P-value 0.06, R2 analog = 0). On multivariate meta-regression, neither of the etiologies showed statistical significance as a possible predictor of clinical success. We performed meta-regression analysis on mortality data and found no significant predictive effect of etiology in EVAC and EST groups, except for anastomotic leaks that almost reached statistical significance as a predictor of mortality with EST (2-sided P-value 0.06, R2 analog = 1). CONCLUSION: EST performed favorably when compared to EST in the treatment of gastroesophageal defects with higher clinical success and lesser mortality.

Management of early pregnancy loss with mifepristone and misoprostol: clinical predictors of success from a randomized trial

Author(s): Sonalkar, Sarita; Koelper, Nathanael C; Creinin, Mitchell D; Atrio, Jessica M; Sammel, Mary D; Schreiber, Courtney A

Predictors of Clinical Success After Surgery for Primary Aldosteronism in the Japanese Nationwide Cohort.

ContextAldosterone-producing adenomas are a curable subtype of primary aldosteronism (PA); however, hypertension persists in some patients after adrenalectomy.ObjectiveTo identify factors associated with, and develop prediction models for, blood pressure (BP) normalization or improvement after adrenalectomy.DesignRetrospective analysis of patients treated between 2006 and 2018, with a 6-month follow-up.SettingA nationwide, 29-center Japanese registry encompassing 15 university hospitals and 14 city hospitals.PatientsWe categorized 574 participants in the Japan Primary Aldosteronism Study, who were diagnosed with PA and underwent adrenalectomy, as BP normalized or improved, on the basis of their presentations at 6 months postsurgery.Main Outcome MeasureThe rate of complete, partial, and absent clinical success. Predictive factors related to BP outcomes after PA surgery were also evaluated.ResultsComplete clinical success was achieved in 32.6% and partial clinical success was achieved in 53.0% of the patients at 6 months postsurgery. The following five variables were independent predictors for BP normalization: ≤7 years of hypertension, body mass index ≤25 kg/m2, no more than one antihypertensive medication, absence of medical history of diabetes, and female sex. The area under the receiver operator characteristic curve was 0.797 in the BP normalization model.ConclusionWe established models that predicted postoperative BP normalization in patients with PA. These should be useful for shared decision-making regarding adrenalectomy for PA.

MP53-01 MICROSCOPIC SPERMATIC CORD DENERVATION FOR CHRONIC ORCHIALGIA/CHRONIC SCROTAL CONTENTS PAIN: PREDICTORS OF SURGICAL SUCCESS

INTRODUCTION AND OBJECTIVES:Microsurgical denervation of the spermatic cord (MDSC) can be helpful for chronic orchialgia but predictors of clinical success are not clearly established. We present o...

Technical and Imaging Outcomes from the UK Registry of Prostate Artery Embolization (UK-ROPE) Study: Focusing on Predictors of Clinical Success.

The UK Registry of Prostate Artery Embolization (UK-ROPE) was a prospective, multicentre study comparing PAE against surgical therapies for symptomatic benign prostatic hyperplasia (BPH). A wealth of data was collected supplementary to the main study outcomes which provide a snapshot of UK PAE practice. We aimed to interpret these data in the hope of providing insight into factors which affect clinical outcome and radiation dose. 216 patients (mean age 66, mean IPSS 21.3) undergoing PAE at 20 British centres from July 2014 to January 2016 were prospectively followed up to 12months with retrospective analysis of the data. Technical outcome was evaluated based on procedural and fluoroscopy times, skin dose and dose area product (DAP). Clinical outcome was evaluated through collection of Qmax, IPSS reduction and prostate volume reduction. Multiple analysis of variance (MANOVA) was used to assess the significance of various patients and procedural factors on clinical outcome and patient dose. Significant predictors of technical outcome which affected patient skin dose included severity of CTA-detected atheroma (p < 0.001), the practitioner (p < 0.001) and use of protective coil embolization (p = 0.019). Predictors of clinical outcome included initial prostate size (dichotomized into groups > 80ml and = <80ml, d = 1, p = 0.0138), embolic agent (spherical particles < 300nm performed best, p = 0.01) and number of arteries embolized (IPSS reduction of 32.9% in unilateral PAE versus 54.4% for bilateral PAE, p = 0.026). We have identified several important factors which are associated with improved clinical outcome and increased patient dose which we hope will facilitate optimal patient selection and encourage improved embolization technique.

Predictors of clinical success with stabilization exercise are associated with lower levels of lumbar multifidus intramuscular adipose tissue in patients with low back pain

Purpose: Investigate the construct validity of prognostic factors purported to predict clinical success with stabilization exercise for low back pain by exploring their associations with lumbar multifidus composition.Methods: Patients with low back pain were recruited from a hospital imaging department. The presence of fivepredictors (age <40 years, positive prone instability test, aberrant trunk flexion movements, straight leg raise range of motion >91°, spinal hypermobility) were identified by standardized physical examination. Predictors were grouped by total positive findings and status on a clinical prediction rule. The proportion of lower lumbar multifidus intramuscular adipose tissue was measured with 3.0 T magnetic resonance imaging. Univariate and multivariate associations were examined with linear regression and reported with standardized beta coefficients (β) and 95% confidence intervals.Results: Data from 62 patients (11 female) with mean (SD) age of 45.2 (11.8) years were included. Total number of predictors (β[95% CI] = −0.37[−0.61,−0.12]; R2 = 0.12), positive prediction rule status (β[95% CI] = −0.57[−0.79,−0.35]; R2 = 0.30), and age <40 years were associated with lower intramuscular adipose tissue (β[95% CI] = −0.55[−0.77,−0.33]; R2 = 0.27). No other individual factors were associated with lumbar multifidus intramuscular adipose tissue.Conclusions: These findings support the construct validity of the grouped prognostic criteria. Future research should examine the clinical utility of these criteria.Implications for RehabilitationLow back pain is the single largest cause of disability worldwide and exercise therapy is recommended by international low back pain treatment guidelines.Lower levels of lumbar multifidus intramuscular adipose tissue were associated with predictors of clinical success with stabilization exercise.Higher proportions of lumbar multifidus intramuscular adipose tissue may help identify patients who require longer duration exercise training, or those who are unlikely to respond to stabilization exercise.