Prognostic Indicator Research Articles

Abstract C024: Evaluation of PI3K/AKT/mTOR pathway signaling as a prognostic indicator in Hispanic Mexican women with breast cancer

Abstract C024: Evaluation of PI3K/AKT/mTOR pathway signaling as a prognostic indicator in Hispanic Mexican women with breast cancer

Cerebrospinal fluid lactate levels as a prognostic indicator in HIV-negative patients with cryptococcal meningitis: a retrospective cohort study

Abstract Background Cryptococcal meningitis (CM) is a severe central nervous system infection. In patients with human immunodeficiency virus (HIV) infections and coexisting CM, elevated baseline cerebrospinal fluid (CSF) lactate levels can predict increased mortality. However, the CSF lactate level’s significance in HIV-negative patients with CM remains unclear, necessitating further investigation to elucidate the potential distinctions and enhance patient management. This study investigated the CSF lactate level significance in HIV-negative patients with CM. Methods This retrospective study utilized data from the clinical databases of patients who underwent lumbar punctures at a medical center in Kaohsiung City, Southern Taiwan. Demographic data, CSF lactate levels, routine CSF analyses, and hematological and neurological findings were evaluated. The optimal CSF lactate threshold value was determined using the Youden index. Results This retrospective study included 70 patients with CM, among whom 44 (63%) and 26 (37%) tested negative and positive for HIV, respectively. The group without HIV exhibited higher CSF lactate levels, with an optimal CSF lactate cut-off point for predicting 90-day mortality of 7.935 mmol/L, resulting in significant predictive accuracies (area under the curve, 0.755; sensitivity, 57.1%; specificity, 100%); this value was an independent mortality predictor in HIV-negative patients. In HIV-negative patients with CM, CSF lactate levels ≥7.935 mmol/L correlated with higher mortality rates but without statistical significance. All HIV-negative patients with CM and CSF lactate levels ≥7.935 mmol/L died within 3 months of admission. Conclusions HIV-negative patients with CM had elevated CSF lactate levels that correlated with adverse outcomes, enabling early identification of high-risk individuals.

Platelet-to-neutrophil ratio predicts hemorrhagic transformation and unfavorable outcomes in acute ischemic stroke with intravenous thrombolysis

BACKGROUND Acute ischemic stroke (AIS) retains a notable stance in global disease burden, with thrombolysis via recombinant tissue plasminogen activator (rtPA) serving as a viable management approach, albeit with variable outcomes and the potential for complications like hemorrhagic transformation (HT). The platelet-to-neutrophil ratio (P/NR) has been considered for its potential prognostic value in AIS, yet its capacity to predict outcomes following rtPA administration demands further exploration. AIM To elucidate the prognostic utility of P/NR in predicting HT and clinical outcomes following intravenous rtPA administration in AIS patients. METHODS Data from 418 AIS patients treated with intravenous rtPA at Thammasat University Hospital from January 2018 to June 2021 were retrospectively analyzed. The relationship between P/NR and clinical outcomes [early neurological deterioration (E-ND), HT, delayed ND (D-ND), and 3-mo outcomes] was scrutinized. RESULTS Notable variables, such as age, diabetes, and stroke history, exhibited statistical disparities when comparing patients with and without E-ND, HT, D-ND, and 3-mo outcomes. P/NR prognostication revealed an optimal cutoff of 43.4 with a 60.3% sensitivity and a 52.5% specificity for 90-d outcomes. P/NR prognostic accuracy was statistically significant for 90-d outcomes [area under the curve (AUC) = 0.562], D-ND (AUC = 0.584), and HT (AUC = 0.607). CONCLUSION P/NR demonstrated an association with adverse 3-mo clinical outcomes, HT, and D-ND in AIS patients post-rtPA administration, indicating its potential as a predictive tool for complications and prognoses. This infers that a diminished P/NR may serve as a novel prognostic indicator, assisting clinicians in identifying AIS patients at elevated risk for unfavorable outcomes following rtPA therapy.

The Use of Neutrophil/Lymphocyte Ratio and Prognostic Nutritional Index for Predicting Mortality in COVID-19 Patients: A Retrospective Study

The Use of Neutrophil/Lymphocyte Ratio and Prognostic Nutritional Index for Predicting Mortality in COVID-19 Patients: A Retrospective Study

Prognosis of colorectal cancer, prognostic index of immunogenic cell death associated genes in response to immunotherapy, and potential therapeutic effects of ferroptosis inducers

Prognosis of colorectal cancer, prognostic index of immunogenic cell death associated genes in response to immunotherapy, and potential therapeutic effects of ferroptosis inducers

Protein Tyrosine Kinase 7 (PTK7) in Breast Cancer: A Retrospective Analysis of Tumour Expression and Association with Clinical Outcome

Protein tyrosine kinase 7 (PTK7), originally known as colon carcinoma kinase (CCK4), is an evolutionary conserved, catalytically defective transmembrane receptor involved in Wnt signalling. PTK7 has been identified as a potential therapeutic target, and a PTK7 antibody drug conjugate (PF-06647020; cofetuzumab pelidotin) has been investigated in phase I clinical trials for triple-negative breast cancer, ovarian cancer, and non-small cell lung cancer. PTK7 protein expression was evaluated in 1136 early-stage invasive breast tumours by immunohistochemistry. In addition, PTK7 mRNA expression in the METABRIC (n = 1980) and the TCGA breast cancer cohorts (n = 1082) was evaluated. Associations between PTK7 expression and clinicopathological criteria and patient outcome were determined. No association between PTK7 protein expression and breast cancer-specific survival was observed; however, PTK7 mRNA expression in the METABRIC cohort was associated with breast cancer-specific survival (p < 0.001). PTK7 protein and mRNA expression were associated with breast cancer-specific survival of patients with a poor prognostic Nottingham Prognostic Index (NPI) and a moderate prognostic NPI, respectively. Taken together, these data indicate that PTK7 expression is associated with patient outcome in subgroups of breast cancer patients.

Commentary: Immune cell infiltration and prognostic index in cervical cancer: insights from metabolism-related differential genes

Commentary: Immune cell infiltration and prognostic index in cervical cancer: insights from metabolism-related differential genes

Predictive values of serum amyloid A, toll‐like receptor 4, and sTREM‐1 for ventilator‐associated pneumonia in elderly patients undergoing abdominal surgery with tracheal intubation and general anesthesia

AbstractObjectivesThis study aimed to conduct a retrospective study to identify inflammatory biomarkers for predicting ventilator‐associated pneumonia in elderly patients.MethodsOur retrospective study included 265 elderly patients (age ≥60 years) undergoing abdominal surgery with tracheal intubation and general anesthesia, with 93 experiencing varying degrees of ventilator‐associated pneumonia during hospitalization, and 172 without. Serum concentrations of serum amyloid A (SAA), toll‐like receptor 4 (TLR4), and soluble myeloid triggering receptor 1 (sTREM‐1) were measured at 24 h post‐operation using enzyme‐linked immunosorbent assay. Comparisons of SAA, TLR4, and sTREM‐1 and other risk factors at 24 h post‐operation between elderly patients with and without ventilator‐associated pneumonia were performed.ResultsThe study revealed a 35.1% incidence of postoperative ventilator‐associated pneumonia among elderly patients. Upregulations of SAA, TLR4, and sTREM‐1 were observed in patients with ventilator‐associated pneumonia. Chronic obstructive pulmonary disease, smoking, and tracheal intubation were identified as independent risk factors. The joint prediction model was demonstrated with superior predictive accuracy (area under the curve = 0.89) compared to individual biomarkers. Correlations with procalcitonin further supported the predictive potential of SAA, TLR4, and sTREM‐1 in an inflammatory response.ConclusionsSAA, TLR4, and sTREM‐1, particularly when combined, serve as valuable prognostic indicators for postoperative ventilator‐associated pneumonia in elderly patients undergoing abdominal surgery with tracheal intubation and general anesthesia. The joint prediction model offered a promising tool for early risk assessment.

Value of preoperative prognostic nutritional index combined with NT-proBNP in predicting acute kidney injury of congenital heart disease children

Objective The study investigates value of preoperative prognostic nutritional index (PNI) combined with N-terminal pro-brain natriuretic peptide (NT-proBNP) in predicting postoperative acute kidney injury (AKI) in congenital heart disease (CHD) children. Methods The clinical data of 108 children with congenital heart disease were retrospectively collected. According to whether AKI occurred 48 h after operation, they were divided into AKI group (n = 32) and non-AKI group (n = 76). The clinical data, preoperative PNI and NT-proBNP levels were compared between the two groups. Multivariate logistic regression analysis was used to analyze the influencing factors of AKI, and the receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of preoperative PNI, NT-proBNP and their combination. Results Multivariate logistic regression analysis showed that Scr, PNI and NT-proBNP were independent risk factors for postoperative AKI in children with congenital heart disease (P < 0.001). The results of ROC curve analysis showed that the area under the curve (AUC) of preoperative PNI, NT-proBNP and their combination in predicting postoperative AKI in children with congenital heart disease were 0.839, 0.738 and 0.907, respectively, and the AUC of their combination was the highest. Conclusion The combined use of preoperative PNI as well as NT-proBNP holds significant value in predicting postoperative AKI in CHD children. Monitoring preoperative PNI and NT-proBNP levels may aid in clinically identifying the risk of postoperative AKI in CHD children, thereby improving their prognosis.

Bidirectional association between perioperative skeletal muscle and subcutaneous fat in colorectal cancer patients and their prognostic significance

IntroductionLow skeletal muscle mass and high adipose tissue coexist across the body weight spectrum and independently predict the survival ratio of colorectal cancer (CRC) patients. This combination may lead to a mutually exacerbating vicious cycle. Tumor-associated metabolic conditions primarily affect subcutaneous adipose tissue, but the nature and direction of its relationship with skeletal muscle are unclear. This study aims to examine the bidirectional causal relationship between skeletal muscle index (SMI) and subcutaneous fat index (SFI) during the perioperative period in CRC patients; as well as to validate the association between perioperative SMI, SFI, and CRC prognosis.MethodsThis population-based retrospective cohort study included patients with stage I-III colorectal cancer who underwent radical resection at the Third Affiliated Hospital of Kunming Medical University between September 2012 and February 2019. Based on inclusion and exclusion criteria, 1,448 patients were analyzed. Preoperative (P1), 2 months postoperative (P2), and 5 months postoperative (P3) CT scans were collected to evaluate the skeletal muscle index (SMI; muscle area at the third lumbar vertebra divided by height squared) and subcutaneous fat index (SFI; subcutaneous fat area at the third lumbar vertebra divided by height squared). A random intercept cross-lagged panel model (RI-CLPM) was used to examine the intra-individual relationship between SMI and SFI, and Cox regression was employed to assess the association between SMI, SFI, recurrence-free survival (RFS), and overall survival (OS).ResultsThe median age at diagnosis was 59.00 years (IQR: 51.00–66.00), and 587 patients (40.54%) were female. RI-CLPM analysis revealed a negative correlation between SFI and subsequent SMI at the individual level: P1-P2 (β = −0.372, p = 0.038) and P2-P3 (β = −0.363, p = 0.001). SMI and SFI showed a negative correlation during P1-P2 (β = −0.363, p = 0.001) but a positive correlation during P2-P3 (β = 0.357, p = 0.006). No significant correlation was found between the random intercepts of SFI and SMI at the between-person level (r = 0.157, p = 0.603). The Cox proportional hazards multivariate regression model identified that patients with elevated SFI had poorer recurrence-free survival (HR, 1.24; 95% CI: 1.00–1.55). Compared to patients with normal preoperative SMI and SFI, those with low SMI or high SFI had poorer recurrence-free survival (HR, 1.26; 95% CI: 1.03–1.55) and overall survival (HR, 1.39; 95% CI: 1.04–1.87). However, no significant association between SMI and SFI and the prognosis of colorectal cancer patients was observed postoperatively.ConclusionIn CRC patients, preoperative muscle loss leads to postoperative fat accumulation, exacerbating muscle loss in a feedback loop. Elevated preoperative SFI predicts poorer survival outcomes. Monitoring SMI and SFI is crucial as prognostic indicators, despite non-significant postoperative associations. Further research is needed to improve patient outcomes.

SNAI1: a key modulator of survival in lung squamous cell carcinoma and its association with metastasis

BackgroundSnail family zinc finger 1 (SNAI1) has been implicated in cancer progression and prognosis across various malignancies. This study aims to elucidate the prognostic significance of SNAI1 expression in Lung Squamous Cell Carcinoma (LUSC) using data from The Cancer Genome Atlas (TCGA) database.MethodsSNAI1 expression levels in LUSC patients were stratified using X-tile software to establish optimal cut-off values. Kaplan-Meier survival analysis was performed to assess the impact of SNAI1 expression on overall survival (OS). Univariate and multivariate Cox regression analyses were conducted to evaluate the prognostic value of SNAI1, considering clinical parameters such as age, clinical stage, and TNM classification. Additionally, we explored the interaction between SNAI1 expression and metastatic status, and performed Gene Set Enrichment Analysis (GSEA) to investigate associated cellular pathways. Correlations between SNAI1 and immune checkpoint molecules were also examined.ResultsKaplan-Meier analysis revealed significant differences in OS among high, medium, and low SNAI1 expression groups (p < 0.001), with median survival times of 1.6, 3.0, and 5.8 years, respectively. Dichotomizing patients into high and low SNAI1 expression groups confirmed that high SNAI1 expression was associated with significantly poorer OS (p < 0.001). SNAI1 remained an independent prognostic factor in multivariate analysis. High SNAI1 expression correlated with poorer survival outcomes regardless of metastatic status, and the combination of high SNAI1 expression and metastasis resulted in the poorest survival. GSEA identified significant associations between SNAI1 and inflammatory, immune response pathways. Positive correlations were observed between SNAI1 and key immune checkpoint molecules, suggesting an interplay with immune checkpoint mechanisms.ConclusionsHigh SNAI1 expression is a robust prognostic indicator of poor survival in LUSC, independent of other clinical factors. Its association with immune checkpoint molecules highlights its potential as a therapeutic target. These findings underscore the prognostic and therapeutic relevance of SNAI1 in LUSC and possibly other cancers. Further research is warranted to explore targeted therapies against SNAI1.

Can Geographical and Socioeconomic Status be the Best Prognostic Indicators of Cardiogenic Shock in the Modern Era of PCI?

Can Geographical and Socioeconomic Status be the Best Prognostic Indicators of Cardiogenic Shock in the Modern Era of PCI?

Recipient functional status impacts on short and long-term intestinal transplant outcomes in United States adults.

Recipient functional status prior to transplantation has been found to impact post-transplant outcomes in heart, liver and kidney transplants. However, information on how functional status, before and after transplant impacts post-transplant survival outcomes is lacking. To investigate the impact of recipient functional status on short and long term intestinal transplant outcomes in United States adults. We conducted a retrospective cohort study on 1254 adults who underwent first-time intestinal transplantation from 2005 to 2022. The primary outcome was mortality. Using the Karnofsky Performance Status, functional impairment was categorized as severe, moderate and normal. Analyses were conducted using Kaplan-Meier curves and multivariable Cox regression. The median age was 41 years, majority (53.4%) were women. Severe impairment was present in 28.3% of recipients. The median survival time was 906.6 days. The median survival time was 1331 and 560 days for patients with normal and severe functional impairment respectively. Recipients with severe impairment had a 56% higher risk of mortality at one year [Hazard ratio (HR) = 1.56; 95%CI: 1.23-1.98; P < 0.001] and 58% at five years (HR = 1.58; 95%CI: 1.24-2.00; P < 0.001) compared to patients with no functional impairment. Recipients with worse functional status after transplant also had poor survival outcomes. Pre- and post-transplant recipient functional status is an important prognostic indicator for short- and long-term intestinal transplant outcomes.

Predictive Mortality of the Prognostic Nutritional Index Combined with APACHE II Score for Critically Ill Tuberculosis Patients.

High mortality rates are commonly found in critically ill patients with tuberculosis (TB), which is due partially to limitations in the existing prognostic evaluation methods. Therefore, we aimed to find more effective prognostic evaluation tools to reduce the mortality rate. Data from critically ill patients with TB admitted to the intensive care unit of The Second Hospital of Nanjing, Nanjing, China, between January 2020 and December 2022 were analyzed retrospectively. A total of 115 patients were enrolled and divided into a survival group (n = 62) and a death group (n = 53) according to 30-day survival. Univariate and least absolute shrinkage and selection operator (LASSO) regression analyses were used to investigate the risk factors for 30-day death in critically ill patients with TB. A prediction model for risk of 30-day mortality was developed for critically ill patients with TB in the intensive care unit. The LASSO regression model showed that the prognostic nutritional index (PNI) and Acute Physiology and Chronic Health Status (APACHE II) scores on the third day after admission to the intensive care unit were independent risk factors for 30-day mortality in critically ill patients with TB (P <0.05). The area under the curve value and that PA3 represents the combination of the PNI and APACHE II score on the third day, which was 0.952 (95% CI: 0.913-0.991, P <0.001), was significantly higher than that of the PNI or the APACHE II score on the third day. The new model is as follows: PA3 = APACHE II score (on the third day) × 0.421 - PNI × 0.204. The PNI combined with the APACHE II score on the third day could well predict the 30-day mortality risk of critically ill patients with TB.

Association of inflammation/nutrition-based indicators with Parkinson’s disease and mortality

ObjectiveThe study explores the association between inflammation/nutrition-based indicators, Parkinson’s disease (PD), and all-cause mortality among adult participants.MethodsThe analysis included 38,091 participants from National Health and Nutrition Examination Survey (NHANES) 1999–2018. Inflammation/nutrition-based indicators were derived from a comprehensive set of parameters, including neutrophil-albumin ratio (NAR), prognostic nutritional index (PNI), monocyte-albumin ratio (MAR), red cell distribution width-albumin ratio (RAR), hemoglobin, albumin, lymphocyte, and platelet (HALP) score, advanced lung cancer inflammation index (ALI), geriatric nutrition risk index (GNRI), and controlling nutritional status (CONUT) score. PD status was determined based on self-reported anti-parkinsonian medication use. Mortality data were obtained from the National Death Index, linked up to December 30, 2019.ResultsAfter multivariate adjustment, all inflammation/nutrition-based indicators showed significant associations with all-cause mortality among adult participants. The random survival forest emphasized the importance of inflammation/nutrition-based indicators and their components in predicting mortality, with PNI and RAR being the most important indicators for predicting all-cause mortality. Individuals with PD have a significantly higher risk of all-cause mortality compared to those without PD (HR = 1.747 [1.363–2.238], P &amp;lt; 0.001) among adults. Additionally, elevated levels of inflammation/nutrition-based indicators are associated with a higher risk of all-cause mortality among individuals with PD compared to those without PD. This suggested a synergistic effect of PD and elevated levels of inflammatory/nutritional indicators on mortality risk. Specifically, individuals with PD and elevated NAR (HR = 2.066 [1.398–3.052], P &amp;lt; 0.001), MAR (HR = 2.249 [1.612–3.138], P &amp;lt; 0.001), RAR (HR = 1.617 [1.179–2.218], P = 0.003), ALI (HR = 1.763 [1.225–2.537], P = 0.002) and CONUT (HR = 2.221 [1.434–3.440], P &amp;lt; 0.001), and not elevated PNI (HR = 1.771 [1.295–2.423], P &amp;lt; 0.001), HALP (HR = 1.738 [1.242–2.432], P = 0.001), and GNRI (HR = 2.689 [1.898–3.811], P &amp;lt; 0.001) have a substantially higher risk of mortality compared to those without PD.ConclusionInflammation and nutrition status play crucial roles in predicting all-cause mortality among adults, particularly in the context of PD. The study underscores the importance of considering both factors in mortality risk assessment and provides valuable insights for future research and clinical practice.

Epstein-Barr virus-positive, primary cutaneous marginal zone lymphoma, with transformation: Case report and review of the literature.

We report a patient with EBV positive PCMZL with subsequent transformation to plasmablastic lymphoma and review the literature for transformed PCMZL to assess clinical and pathologic characteristics. In the case we describe, the patient presented with multifocal PCMZL, developed large B cell transformation with plasmacytic differentiation, followed by plasmablastic transformation (PBL), and ultimately died of disease progression despite multiple lines of therapy. Past history was significant for psoriatic arthritis (multiple prior lines of immunomodulatory therapy). The lymphomas and non-involved bone marrow share the same somatic DNMT3A and TET2 mutations, suggesting clonal relatedness and an association with clonal hematopoiesis (CH). Eighteen cases complied the cohort (seventeen cases from the literature and the case reported herein). Nearly half of the eighteen cases of PCMZL with transformation died of progressive disease (44%). Transformed cases were more commonly seen in patients with >2 sites at initial diagnosis. EBV was assessed in 5 patients, 3 were positive (all died of disease). Two patients with NGS studies demonstrated TET2 and DNMT3A mutations. Transformation of EBV positive PCMZL appears to be a poor prognostic indicator, with our reported case being the first well defined case transformed to PBL, suspected to arise from myeloid-CH.

Inflammation-related markers and prognosis of alpha-fetoprotein producing gastric cancer

BACKGROUND Inflammation-related markers including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI) and prognostic nutritional index (PNI) could reflect tumor immune microenvironment and predict prognosis of cancers. However, it had not been explored in alpha-fetoprotein (AFP) producing gastric cancer (GC). AIM To determine the predictive value of inflammation-related peripheral blood markers including as NLR, PLR, MLR, SII, SIRI and PNI in the prognosis of AFP- producing GC (AFPGC). Besides, this study would also compare the differences in tumor immune microenvironment, clinical characteristics and prognosis between AFPGC and AFP- GC patients to improve the understanding of this disease. METHODS 573 patients enrolled were retrospectively studied. They were divided into AFP+ group (AFP ≥ 20 ng/mL) and AFP- group (AFP &lt; 20 ng/mL), comparing the levels of NLR/PLR/MLR/SII/SIRI/PNI and prognosis. In AFP+ group, the impact of NLR/PLR/MLR/SII/SIRI/PNI and their dynamic changes on prognosis were further explored. RESULTS Compared with AFP- patients, AFP+ patients had higher NLR/PLR/MLR/SII/SIRI and lower PNI levels and poorer overall survival (OS). In the AFP+ group, mortality was significantly lower in the lower NLR/PLR/MLR/SII/SIRI group and higher PNI group. Moreover, the dynamic increase (NLR/PLR/MLR/SII/SIRI) or decrease (PNI) was associated with the rise of mortality within 1 year of follow-up. CONCLUSION Compared with AFP- patients, the level of inflammation-related peripheral blood markers significantly increased in AFP+ patients, which was correlated with OS of AFP+ patients. Also, the gradual increase of SII and SIRI was associated with the risk of death within one year in AFP+ patients. AFPGC should be considered as a separate type and distinguished from AFP- GC because of the difference in tumor immune microenvironment. It requires basic experiments and large clinical samples in the future.

Indications for Spinal Anesthesia in Simultaneous Operations for Combined Gynecological Diseases

In the early postoperative period, complications usually occur in groups with a significant and high degree of surgical and anesthetic risk. For this reason, studying the indications for spinal anesthesia is relevant. To study indications for spinal anesthesia during simultaneous operations of combined gynecological diseases. The results of 123 patients’ surgical treatment with combined surgical and gynecological diseases were analyzed depending on the surgical and anesthetic risk. According to a retrospective analysis and study of prognostic indicators, postoperative complications occurred in patients with a significant and high degree of surgical and anesthetic risk. Simultaneous operations are contraindicated in cases of significant and extremely high degrees of surgical and anesthetic risk; such patients must be operated on in stages.

Systemic immune-inflammation and prognostic immune nutritional index in oral squamous cell carcinoma patients.

Aim: To investigate the systemic immune-inflammation index and prognostic immune nutritional index in the prognostic evaluation of oral squamous cell carcinoma.Materials & methods: We analyzed retrospectively the relationship between systemic immune-inflammation index, prognostic immune nutritional indexand clinicopathological variables and the overall survival of 262 patients who underwent radical surgery.Results: Multivariate analysis showed high systemic immune-inflammation index (Hazard ratio=3.062, 95% CI:1.021-8.251), low prognostic immune nutritional index (Hazard ratio=0.297, 95% CI:0.139-0.636), tumor node metastasis classification 3-4 (Hazard ratio=9.862, 95% CI:4.658-20.880) patients have worse overall survival.Conclusion: Preoperative systemic immune-inflammation index and prognostic immune nutritional index are independent risk factors for prognostic survival status in oral squamous cell carcinoma.

A multicomponent personalized prevention program in the primary care setting: a randomized clinical trial in older people with noncommunicable chronic diseases (Primacare_P3 study)

BackgroundMulticomponent interventions based on a comprehensive geriatric assessment (CGA) could promote active aging and improve health status in older people with Noncommunicable Chronic Diseases (NCDs), but conflicting evidences are available.AimTo evaluate the efficacy of a CGA-based multicomponent personalized preventive program (PPP) in reducing unplanned hospitalization rates during 12-month follow-up in community-dwelling older people with NCDs.Materials and methodsIn this randomized clinical trial (RCT), 1216 older adults recruited by 33 general practitioners (GPs) will be randomly allocated to intervention group (IG) or usual care control group (CG). The IG will receive a multicomponent PPP developed on the findings of the CGA-based Multidimensional Prognostic Index short-form (Brief-MPI), including structured interventions to improve functional, physical, cognitive, and nutritional status, to monitor NCDs and vaccinations, and to prevent social isolation. Participants in the CG will receive usual care. Brief-MPI, resilience, and health-related quality of life will be assessed after 6 and 12 months. Moreover, saliva samples will be collected at baseline in IG to measure biomarkers of oxidative stress, inflammatory cytokines, and oral microbiome.Expected resultsThe CGA-based PPP might reduce unplanned hospitalization rates and potentially institutionalization rates, emergency department (ED) and unplanned GP visits, and mortality. Further outcomes explored in the IG will be the adherence to PPP, resilience, health-related quality of life, and multidimensional frailty as assessed by the Brief-MPI.ConclusionsResults will suggest whether the CGA-based multicomponent PPP is able to improve specific outcomes in a primary care setting.Trial registrationClinicalTrials.gov; identifier: NCT06224556; Registered January 25, 2024.