Prognostic Marker In Patients Research Articles

Effect of the 3q26-coding oncogene SEC62 as a potential prognostic marker in patients with ovarian neoplasia.

With approximately 220,000 newly diagnosed cases per year, ovarian cancer is among the most frequently occurring cancers among women and the second leading cause of death from gynecological malignancies worldwide. About 70% of these cancers are diagnosed in advanced stages (FIGO IIB-IV), with a 5-year survival rate of 20-30%. Due to the poor prognosis of this disease, research has focused on its pathogenesis and the identification of prognostic factors. One possible approach for the identification of biological markers is the identification of tumor entity-specific genetic "driver mutations". One such mutation is 3q26 amplification in the tumor driver SEC62, which has been identified as relevant to the pathogenesis of ovarian cancer. This study was conducted to investigate the role of SEC62 in ovarian malignancies. Patients with ovarian neoplasias (borderline tumors of the ovary and ovarian cancer) who were treated between January 2007 and April 2019 at the Department of Gynecology and Obstetrics, Saarland University Hospital, were included in this retrospective study. SEC62 expression in tumor tissue samples taken during clinical treatment was assessed immunohistochemically, with the calculation of immunoreactivity scores according to Remmele and Stegner, Pathologe, 1987, 8, 138-140. Correlations of SEC62 expression with the TNM stage, histological subtype, tumor entity, and oncological outcomes (progression-free and overall survival) were examined. The sample comprised 167 patients (123 with ovarian cancer and 44 with borderline tumors of the ovary) with a median age of 60 (range, 15-87)years. At the time of diagnosis, 77 (46%) cases were FIGO stage III. All tissue slides showed SEC62 overexpression in tumor cells and no SEC62 expression in other cells. Median immunoreactivity scores were 8 (range, 2-12) for ovarian cancer and 9 (range, 4-12) for borderline tumors of the ovary. Patients with borderline tumors of the ovary as well as patients with ovarian cancer and an immunoreactive score (IRS) ≤ 9 showed an improved overall survival compared to those presenting with an IRS score >9 (p = 0.03). SEC62 seems to be a prognostic biomarker for the overall survival of patients with ovarian malignancies.

Prognostic value of reactive hyperemia index using peripheral artery tonometry in patients with heart failure

Given the high prevalence and poor prognosis of heart failure (HF), finding prognostic factors for patients with HF is crucial. This study investigated the prognostic value of reactive hyperemia index (RHI), a measure of endothelial function, in HF. A total of 90 HF patients (mean age, 63.7 ± 13.2 years; female, 25.6%) with a history of hospitalization for HF treatment were prospectively enrolled. RHI was measured using digital arterial tonometry in a stable condition. Clinical events, including all-cause death and HF admission, were assessed. During the median follow-up of 3.66 years (interquartile range, 0.91–4.94 years), 26 clinical events (28.9%) occurred. Although there were no significant differences in risk factors and laboratory findings according to the occurrence of clinical events, the RHI value was significantly lower in patients with clinical events than in those without (1.21 ± 0.34 vs. 1.68 ± 0.48; P < 0.001). Kaplan–Meier survival analysis showed that a lower RHI value (< 1.48) was associated with a significantly higher incidence rate of clinical events (log-rank P < 0.001). In multivariable cox regression analysis, a low RHI value (< 1.48) was associated with an increased risk of clinical events (hazard ratio, 14.09; 95% confidence interval, 3.61–54.99; P < 0.001) even after controlling for potential confounders. Our study showed that reduced RHI was associated with an increased risk of adverse clinical outcomes in HF. This suggests that endothelial dysfunction may be an important prognostic marker in patients with HF.

Evaluation of Dynamic Variation in Red Cell Distribution Width as a Septic Marker in Comparison with Procalcitonin Levels and Clinical Scores in Patients with Sepsis or Septic Shock: A Prospective Observational Study

BACKGROUND: Sepsis is a dysregulated host response to infection resulting in potentially life-threatening organ dysfunction. Elevation in red cell distribution width (RDW), a simple routinely done investigation, could be a prognostic marker in these patients. AIM: We performed this prospective observational study to assess role of dynamic variation of RDW in predicting 30-day mortality in patients with sepsis or septic shock presenting and getting admitted in intensive care unit (ICU) in Fayoum, Egypt. METHODS: Between January 2019 and January 2021, 150 patients with sepsis or septic shock at admission were prospectively evaluated for association between RDW value on admission, on day 4, on day 7, and 30-day mortality. To find out factors associated independently with 30-day mortality, we applied multivariate logistic regression analysis and used the analysis to develop nanogram for prediction of mortality on admission. RESULTS: Among 150 patients, 89 (59.3%) were male. Mean age of the patients was 59.6 ± 12.28 years. Regarding RDW on admission (RDW-0), the mean was 14.1 ± 1.9 while on day 4 (RDW-4), the mean was 14.5 ± 1.97, and on day 7 (RDW-7), the mean was 14.4 ± 2.03. Seventy-four (49.3%) patients died during the period of 30 days follow-up. Multiple logistic regression models for the parameters associated with the mortality outcome at admission were done, for age, higher age was associated with higher probability of mortality, OR = 1.07 (95% CI: 1.02, 1.13). Male sex was associated with lower probability of mortality as compared to females, OR = 0.02 (95% CI: 0.06, 0.80). Higher acute physiologic assessment and chronic health evaluation (APACHE) II score, RDW value, and procalcitonin level, all were associated with higher mortality probability. For APACHE II score, higher level was associated with higher odds of mortality, OR = 1.16. For RDW value on admission, higher value was associated with higher odds of mortality, OR = 1.66. For procalcitonin level at admission, higher level was associated with higher odds of mortality, OR = 1.54. Odds for mortality for those who showed any increase in RDW in day 4 as compared to day 0 are higher as compared to those who showed a decrease or no change in RDW, OR = 2.8, p-value = 0.007. CONCLUSIONS: We found that an increase in RDW value on admission and on day 4 is significantly associated with mortality. And that, an increase in RDW value from day 0 to day 4 is also significantly associated with mortality Therefore, a combination of baseline RDW value and an increase in serial RDW values can be a promising independent prognostic marker in patients with sepsis or septic shock.

Fibrinogen-to-lymphocyte Ratio Predicts the Outcomes of Hypopharyngeal Squamous Cell Carcinoma Treated With Definitive Radiotherapy.

Previous studies have identified several inflammatory biomarkers that are useful as prognostic biomarkers for various cancer types. However, the fibrinogen-to-lymphocyte ratio (FLR) has not been addressed in head and neck squamous cell carcinoma. Here, we aimed to examine the value of pretreatment FLR as a prognostic marker in patients who received definitive radiotherapy for hypopharyngeal squamous cell carcinoma (HpSCC). This retrospective study included 95 patients treated with definitive radiotherapy for HpSCC between 2013 and 2020. The prognostic factors for progression-free (PFS) and overall (OS) survival were identified. The optimal cut-off value of pretreatment FLR for discriminating PFS was 2.46. Based on this value, 57 and 38 patients were classified into groups with high and low FLR, respectively. A high FLR was significantly associated with advanced local disease and overall stage, and with the development of synchronous second primary cancer compared with a low FLR. The high FLR group had significantly lower PFS and OS rates than the low FLR group. Multivariate analysis showed that having a high pretreatment FLR was an independent prognostic factor for poorer PFS and OS [PFS: hazard ratio (HR)=2.14, 95% confidence interval (CI)=1.09-4.19, p=0.026; OS: HR=2.86, 95% CI=1.14-7.20, p=0.024]. The FLR has a clinical effect on PFS and OS in patients with HpSCC, suggesting that it has potential application as a prognostic factor for patients with HpSCC.

Loss of ficolin-3 expression is associated with poor prognosis in patients with hepatocellular carcinoma.

Background: Ficolin-3 (FCN3) is a well-known circulating pattern recognition molecule which plays a role in host immune responses to cancer via activation of the lectin complement pathway. Nevertheless, the clinical significance of FCN3 in patients with hepatocellular carcinoma (HCC) is unclear. Methods: Eighty-seven HCC patients who received hepatectomy at our hospital were included. Immunohistochemical staining was used to assess the FCN3 expression in both tumorous and non-tumorous tissues from the patients, who were classified into high and low expression groups. Differences in clinicopathological characteristics between the two groups were then analyzed. Results: Survival was significantly associated with FCN3 immunohistochemical score (p for trend = 0.048). Kaplan-Meier analysis revealed a higher overall survival rate in the patients with a high FCN3 expression than in those with a low FCN3 expression (p=0.031). A high FCN3 expression in tumor tissue was independently associated with better overall survival (p=0.042). However, multivariate analysis showed that FCN3 expression was not an independent risk factor for overall survival. Conclusion: Our findings suggest that FCN3 is significantly related to the prognosis of HCC. FCN3 may be a prognostic marker in patients with HCC.

The prognostic effect of immunohistochemical staining rates in patients with non-muscle-invasive bladder cancer.

Despite the follow-up protocols developed in non-muscle-invasive bladder cancer patients, progression and recurrence could not be prevented. We aimed to investigate whether proteins such as OCT-4, CD47, p53, Ki-67, and Survivin, which increase in bladder cancer cells, can be used as prognostic markers for patients with non-muscle-invasive bladder cancer. The study included a total of 89 patients with newly diagnosed non-muscle-invasive bladder cancer between January 2015 and December 2020. Levels of OCT-4, CD47, p53, Kİ-67, and Survivin proteins in cancer cells were determined with a semi-quantitative immunohistochemical experiment. Pathological data and survival rates were compared according to the staining rates. Data obtained in the study were analyzed statistically with SPSS 22.0 (SPSS, Chicago, IL, USA). The mean age of the patients was 64.25 ± 9.91 years, and the median follow-up period was 55 months. Recurrence rate was determined to be 36% (n = 32), and the rate of progression at 40.4% (n = 36). The staining rates were stronger for each marker in the progression group and advanced-stage tumors (p < 0.001). The findings of the multivariate analysis carried out as part of the study showed that older age and higher tumor stage were independent risk factors for recurrence-free survival (HR = 1.048 and 7.074, respectively; P = 0.02). Also, higher tumor stages, diameters, and grades were associated with reduced progression-free survival (HR = 0.105, 0.395, 0.225, respectively; P < 0.05). Although immunohistochemical staining rates are promising, it is more appropriate to use tumor characteristics when assessing survival rate in patients with non-muscle-invasive bladder cancer.

Systemic immune inflammation index and pan-immune inflammation value as prognostic markers in patients with idiopathic low and moderate risk membranous nephropathy.

We aimed to investigate the prognostic values of systemic immune inflammation index and pan-immune inflammation value in patients with idiopathic low and moderate risk membranous nephropathy. All membranous nephropathy patients diagnosed in the nephrology clinic between January 2015 and January 2022 were reviewed retrospectively. Patients with idiopathic membranous nephropathy were included. The patients were divided into two groups; the complete remission group: whose proteinuria decreased below 0.3 g/day and serum albumin level above 3.5 g/dL after 6 months of conservative treatment, and the non-remission group: all other patients. Groups were compared in terms of systemic immune inflammation index and pan-immune inflammation value. Patients in the non-remission group had significantly higher systemic immune-inflammation index (SII) and pan-immune-inflammation value (PIV) than patients in the complete remission group (p<0.05). An SII of 1,056.2 was found to have 63.6% sensitivity and 100% specificity in predicting non-remission, and a PIV of 447.4 was found to have 100% sensitivity and 70.6% specificity in predicting non-remission. SII and PIV are reliable markers for predicting non-remission in patients with low and moderate risk idiopathic MN.

PS-C34-8: INFLUENCE OF RISK FACTORS IN THE DEVELOPMENT OF ARTERIAL STIFFNESS IN PATIENTS WITH UNCONTROLLED ARTERIAL HYPERTENSION

Introduction: Arterial stiffness is an unfavorable prognostic marker in patients with arterial hypertension (AH). Early diagnosis of the development of arterial stiffness contributes to the selection of pathogenetic therapy aimed at vascular protection. As noted in the recommendations for hypertension, markers of vascular damage in hypertension are pulse pressure (PP) and pulse wave velocity (PWV) &gt; 10 m/s. However, in the conditions of practical medicine in our republic, there is no possibility of applanation tonometry to assess PWV. Aim: to search for risk factors associated with the early development of arterial stiffness in patients with uncontrolled hypertension. Material and Methods: 133 patients with an average age of 59.13 ± 8.18 years with uncontrolled hypertension, 22.5% of who were smokers. All patients underwent office blood pressure measurements, ECG, duplex scanning of the carotid arteries, applanation tonometry to determine PWV (Sphygmocor, Atcor, Australia) on the segment of the carotid-femoral artery, lipid spectrum, creatinine, and blood serum glucose. Results: Office systolic, diastolic and pulse BP (SBP, DBP and PP) were 164.92 ± 19.0 mm Hg, 99.2 ± 9.08 mm Hg, 65.73 ± 13.67 mm Hg, which corresponded to 2 degrees of arterial hypertension. Central SBP, DBP and PP: 166.96 ± 29.75 mm Hg, 84.8 ± 14.59 mm Hg, PD 81.96 mm Hg. respectively. An increase in PP characterized the development of vascular stiffness in patients with uncontrolled hypertension. At the same time, PWV was 10.8 ± 2.03 m/s; in 60% of patients, PWV exceeded the standard values (&gt; 10 m/s). There was a thickening of the thickness of the intima-media complex (IMC) of the common carotid artery up to 1.11 ± 0.18 mm. The correlation analysis performed showed a direct correlation between PWV and the age of patients (r = 0.383, p = 0.0001), tobacco smoking (r = 0.2, p = 0.004), SBP (r = 0.15, p = 0.046), blood glucose level (r = 0.2, p = 0.008), CMM thickness (r = 0.3, p = 0.0001). Conclusion: The results showed an association of age, SBP, smoking, fasting glucose levels, IMT thickness with the development of arterial stiffness in patients with uncontrolled hypertension. These markers can be determined at the primary health care level and included in the stratification of the risk of vascular damage in patients with uncontrolled hypertension.

Influence of the Oral Health Assessment Tool Score on Survival of Patients With Esophageal Cancer.

We investigated the influence of the preoperative Oral Health Assessment Tool (OHAT) score on the outcomes of patients with esophageal cancer after curative surgery. This study included 90 patients with esophageal cancer who underwent curative surgery and who were screened with the OHAT between 2008 and 2021. The OHAT consists of eight categories with three possible scores. The risk factors for 5-year overall survival (OS) and recurrence-free survival (RFS) were identified. Patients were divided into healthy (n=42) and unhealthy (n=48) groups. The OHAT score was identified as a significant risk factor for postoperative pneumonia (11.9% vs. 43.8%, p=0.001) and postoperative hospital stay (20.5 days vs. 50.1 days, p=0.042). The 5-year OS rate after surgery was 71.2% in the healthy group and 43.2% in the unhealthy group, which was a significant difference (p=0.015). A multivariate analysis showed that a high OHAT score was a significant independent factor for 5-year OS (p=0.034). The OHAT score was a useful prognostic marker in patients who underwent curative surgery for esophageal cancer. To improve the oncological outcomes of patients with esophageal cancer, it is necessary to carefully plan perioperative oral/dental care using the OHAT score.

The role of carcinoembryonic antigen-related cell adhesion molecule 1 in cancer.

The Carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM1), also known as CD66a, is a member of the immunoglobulin superfamily. CEACAM1 was shown to be a prognostic marker in patients suffering from cancer. In this review, we summarize pre-clinical and clinical evidence linking CEACAM1 to tumorigenicity and cancer progression. Furthermore, we discuss potential CEACAM1-based mechanisms that may affect cancer biology.

Coronavirus disease-2019 and heart: assessment of troponin and cardiovascular comorbidities as prognostic markers in patients hospitalized with coronavirus disease-2019 in a tertiary center in Brazil.

Our study aimed to evaluate the correlation of cardiac troponin T levels with comorbidities and in-hospital outcomes in patients with coronavirus disease-2019 in Brazil. Data from a cohort of 3,596 patients who were admitted with suspected coronavirus disease-2019 in a Brazilian tertiary center, between March and August 2020, were reviewed. A total of 2,441 (68%) patients had cardiac troponin T determined in the first 72 h of admission and were stratified into two groups: elevated cardiac troponin T (cardiac troponin T >0.014 ng/mL) and normal cardiac troponin T. Associations between troponin, comorbidities, biomarkers, and outcomes were assessed. Regression models were built to assess the association of several variables with in-hospital mortality. A total of 2,441 patients were embraced, of which 924 (38%) had normal cardiac troponin T and 1,517 (62%) had elevated cardiac troponin T. Patients with elevated cardiac troponin T were older and had more comorbidities, such as cardiovascular disease, hypertension, diabetes, arrhythmia, renal dysfunction, liver disease, stroke, cancer, and dementia. Patients with abnormal cardiac troponin T also had more altered laboratory parameters on admission (i.e., leukocytes, C-reactive protein, D-dimer, and B-type natriuretic peptide), as well as more need for intensive care unit, vasoactive drugs, mechanical ventilation, dialysis, and blood transfusion. All-cause mortality was markedly higher among patients with increased cardiac troponin T (42 vs. 16%, P<0.001). Multiple regression analysis demonstrated that in-hospital mortality was not independently associated with troponin elevation. This study showed that cardiac troponin T elevation at admission was common and associated with several comorbidities, biomarkers, and clinical outcomes in patients hospitalized with coronavirus disease-2019, but it was not an independent marker of in-hospital mortality.

Combination of Neutrophil Count and Gensini Score as a Prognostic Marker in Patients with ACS and Uncontrolled T2DM Undergoing PCI

Background: Several biomarkers have been studied as prognostic indicators among people with diabetes and coronary artery disease (CAD). The purpose of this study was to determine the prognostic value of neutrophil counts and the Gensini score in patients with diabetes and ACS undergoing percutaneous coronary intervention (PCI). Methods: A total of 694 people with ACS and T2DM who simultaneously had elevated HBA1c received PCI. Spearman rank correlation estimates were used for correlation evaluation. Multivariate Cox regression and Kaplan-Meier analysis were used to identify characteristics associated with major adverse cardiovascular and cerebrovascular events (MACCEs) and patient survival. The effects of single- and multi-factor indices on MACCEs were evaluated through receiver operating characteristic curve analysis. Results: The Gensini score and neutrophil count significantly differed between the MACCE and non-MACCE groups among patients receiving PCI who had concomitant ACS and T2DM with elevated HBA1c (P&lt;0.001). The Gensini score and neutrophil count were strongly associated with MACCEs (log-rank, P&lt;0.001). The Gensini score and neutrophil count, alone or in combination, were predictors of MACCEs, according to multivariate Cox regression analysis (adjusted hazard ratio [HR], 1.005; 95% confidence interval [CI], 1.002–1.008; P=0.002; adjusted HR, 1.512; 95% CI, 1.005–2.274; P=0.047, respectively). The Gensini score was strongly associated with neutrophil count (variance inflation factor ≥ 5). Area under the curve analysis revealed that the combination of multivariate factors predicted the occurrence of MACCEs better than any single variable. Conclusion: In patients with T2DM and ACS with elevated HBA1c who underwent PCI, both the Gensini score and neutrophil count were independent predictors of outcomes. The combination of both predictors has a higher predictability.

Study of Stress Hyperglycemia as a Prognostic Factor in Acute Ischemic Stroke at a Tertiary Care Hospital

Background: The second most prevalent cause of disability and death worldwide, stroke is silently taking on the characteristics of an epidemic. Almost 85% of the all strokes are ischemic strokes. Objective: To assess the stress hyperglycemia as a prognostic factor in acute ischemic stroke at a tertiary care hospital. Design of the Study: It was a case control study. Place and Duration of Study: This study was conducted at the Department of medicine &amp; Allied Services Hospital Lahore from March 2022 August 2022. Patients and Methods: Total 100 patients with Computerized Tomography (CT) Brain evidence of acute ischemic stroke who met the inclusion criteria were included in the study. At admission, a thorough history was taken and clinical examination was performed. The National Institutes of Health Stroke Scale (NIHSS scale) was used to measure the patient’s neurological state. Fasting Blood sugar (FBS) and Glycosylated Hemoglobin (HBA1c) were performed. Patients' functional recovery was measured by comparing their NIHSS scores on the day of admission and after 7 days in the hospital. Results of the Study: Most of the patients enrolled in our study had age of 61 to 70 years. In study sample 56% of patients were male and 44% were female. Out of 100 patients 56 had stress hyperglycemia and 44 were without stress hyperglycemia. Functional recovery was greater in patients with normoglycemia than in patients with stress hyperglycemia (based on differences in NIHSS score on day one and day seven). The mortality was observed to be 9.2% in patients who had stress hyperglycemia. The mean NIHSS scores was 3.45±1.64 in patients with stress hyperglycemia and 4.50 ± 1.05 was in participants with normoglycemia. Practical Implication: The present study was carried out to know whether stress hyperglycemia can be a prognostic marker in patients of acute ischemic stroke. Conclusion: When compared to patients with stress hyperglycemia, functional recovery was better in patients with normoglycemia. This study demonstrates that patients with normoglycemia had greater functional recovery as compared to patients with stress hyperglycemia, as measured by the difference between the NIHSS scores. As a result, patients with normoglycemia had better outcomes than those with stress hyperglycemia. Keywords: Stress hyperglycemia, Normoglycemia, Acute Ischemic Stroke, Prognostic Factor, NIHSS

Prognostic Role of Preoperative D-dimer Levels in Patients With Stage I-III Colorectal Cancer.

As D-dimer levels have been reported to reflect cancer activity, preoperative D-dimer levels may serve as a prognostic marker in patients with colorectal cancer. The aim of this study was to evaluate the prognostic significance of preoperative D-dimer levels in patients with stage I-III colorectal cancer who underwent curative surgery. A total of 264 patients who underwent curative surgery for stage I-III colorectal cancer between January 2015 and December 2019 were enrolled in this study. The median preoperative D-dimer level was 0.8 μg/ml (range=0.4-42.5 μg/ml). Based on the results of a receiver operating characteristic curve analysis, we set 1.45 as the cut-off value and classified patients into the low (n=215) and high D-dimer (n=49) groups. The high D-dimer group had significantly lower relapse-free and overall survival in comparison to the low D-dimer group (p<0.0001, p<0.0001, respectively). Preoperative D-dimer levels can serve as a prognostic marker for stage I-III colorectal cancer.

MiR-21, miR-93, miR-191, miR-let-7b, and miR-499 Expression Level in Plasma and Cerebrospinal Fluid in Patients with Prolonged Disorders of Consciousness

In recent decades, significant progress has been achieved in understanding the mechanisms of disturbance and restoration of consciousness in patients after severe brain damage resulting in prolonged disorders of consciousness (pDOC). MicroRNAs (miRs) may be potential candidates as possible biomarkers for the classification of disease subtypes, and prognosis in patients with pDOC. The aim of the study was to analyze miRs expression levels (hsa-miR-21-5p, hsa-miR-93-5p, hsa-miR-191-5p, mmu-miR-499-5p, hsa-let-7b-5p) by a real-time polymerase chain reaction in plasma and cerebrospinal fluid (CSF) from patients with pDOC and to identify a potential biomarker for dividing patients into groups according to disease severity. We analyzed the levels of investigated miRs in pDOC patients, divided by etiology, CRSI, and the total group compared with controls. Our results showed that dividing patients with pDOC into groups according to the etiology of the disease resulted in the most significant differences in the levels of miR-93, -21, and -191 in CSF and plasma samples between groups of patients. Among the analyzed miRs, we did not find a marker that would help to distinguish VS/UWS patient groups from MCS. Examining of miRs as possible prognostic markers in patients with pDOC, the starting point seems to be the cause that led to the development of the disease.

A retrospective analysis of tumor infiltrating lymphocytes in head and neck squamous cell carcinoma patients treated with nivolumab

Nivolumab, an immune checkpoint inhibitor is the first-line therapy for platinum-resistant recurrent/metastatic head and neck cancer, and highly effective for some patients. However, no factors have been identified that could predict response or prognosis after nivolumab administration. We retrospectively investigated the association between tumor infiltrating lymphocytes (TILs) of initial pathology and prognosis in patients treated with nivolumab. Twenty-eight patients with human papilloma virus and Epstein–Barr virus unrelated head and neck squamous cell carcinoma were enrolled. CD8+cells, FoxP3+cells and FoxP3−CD4+cells in the tumoral and peritumoral stromal area and PD-L1 were measured. In result, FoxP3−CD4+TIL, FoxP3+TIL, and CD8+TIL were not correlated with survival in either intratumoral and stromal area. In univariate analysis, objective response was significant prognostic factor both in progression-free survival and overall survival (p = 0.01, 0.006, respectively). PD-L1 was also significant prognostic factor both in progression-free survival and overall survival (p = 0.01, 0.01, respectively). ECOG Performance status was a significant prognostic factor in overall survival (p = 0.0009). In the combined analysis of stromal CD8+TIL and PD-L1, PD-L1 positive with high stromal CD8+TIL subgroups had a better prognosis than PD-L1 negative with low stromal CD8+TIL subgroups in progression-free survival (p = 0.006). Although these results require a further investigation, PD-L1 and ECOG Performance status and the combination of stromal CD8+TIL and PD-L1 positivity have potential as useful prognostic markers in patients of virus unrelated head and neck squamous cell carcinoma treated with nivolumab.

369 PENTRAXIN 3 AS A DIAGNOSTIC AND PROGNOSTIC MARKER OF ACTIVE MYOCARDITIS

Abstract Background Pentraxin 3 (PTX3) is an acute phase protein, which regulates the outcomes of inflammation. Currently, there are no myocarditis-typical biomarkers that allow a non-invasive diagnosis, and endomyocardial biopsy (EMB) is still the gold standard. Finally, risk stratification is often challenging in these patients. Aim To investigate whether PTX3 could be expressed in cardiomyocytes and released during myocarditis, serving as a novel and independent diagnostic indicator of myocardial inflammation, and contributing to prognosis prediction. Methods Fifty-five patients with a diagnosis of acute or chronic active myocarditis proven by cardiac magnetic resonance (CMR) and/or endomyocardial biopsy (EMB), were included. First, we evaluated tissue PTX3 expression by immunohistochemistry (IHC). Then, we assessed circulating blood PTX3 by ELISA technique. Results On cardiac tissue, PTX3 at IHC did not localize in the interstitium, and showed an inconstant expression in the vascular endothelium, but a marked staining by cardiomyocytes in all myocarditis patients. The only exception was represented by two patients with systemic COVID-19, with SARS-CoV-2 and PVB-19 intracardiac genomes, respectively, who showed a diffuse cardiac PTX3 expression. Remarkably, at semi-quantitative pixel analysis, viral aetiology showed higher levels of tissue expression, rather than the autoimmune one. Circulating PTX3 levels were significantly higher in myocarditis patients than controls, with pathologic values in 87% of myocarditis patients, and none among controls. Remarkably, plasma PTX3 proved to be more sensitive in myocarditis detection than CRP, ESR, troponin T, and NT-proBNP. As regards of prognosis, we observed that patients with heart failure (HF) presentation all had elevated PTX3 levels, as compared with chest pain or arrhythmia. Remarkably, patients with reduced LVEF (&amp;lt;50%) at admission who recovered during follow-up had higher baseline PTX3 levels, rather than those whose systolic function did not improve. Conclusions Tissue PTX3 is mostly expressed by cardiomyocytes in patients with active myocarditis on EMB samples. In addition, plasma PTX3 is a sensitive diagnostic and prognostic marker in patients with inflammatory cardiomyopathy.

A STUDY ON THE PROGNOSTIC SIGNIFICANCE OF HYPONATREMIA IN ACUTE MYOCARDIAL INFARCTION- A PROSPECTIVE LONGITUDINAL STUDY

Background: Hyponatremia, dened as a serum sodium concentration &lt;135 mEq/L, is the most common electrolyte disorder in hospitalized patients. Hyponatremia also increases the morbidity and mortality following myocardial infarction. MI is a major cause of death and is a global health problem reaching epidemic in both developed as well as in developing countries. Aims and Objectives: To study hyponatremia as a prognostic marker in patients with acute myocardial infarction-STEMI and NSTEMI. Material and Methods: This prospective, longitudinal observational study was conducted during December 2018 – October 2020 in 152 cases of acute MI. Results: Male preponderance in the patients hospitalised due to acute MI was 73.03%. The mean age of females was 59.46±9.42 years affected by acute MI was more than males i.e. 53.23±9.92 years. Hyponatremia was present in 39.47% of the cases with acute MI. Mild hyponatremia was the most prevalent 71.67% and severe hyponatremia was the least prevalent 3.33%. Diabetes mellitus was more prevalent in cases of MI with hyponatremia 53.33% vs 25%. The GRACE scores were higher in the cases having hyponatremia and increases with the increase in severity of hyponatremia. The TIMI scores were higher in the cases having hyponatremia and increases with the increase in severity of hyponatremia. The mean duration of hospital stay was 9.99 ± 8.69 days. STEMI was more prevalent 75.66% than NSTEMI. AWMI cases were more in the population with hyponatremia 78% than in the population with normal serum sodium 53.85%. Acute MI cases with hyponatremia had lower mean LVEF than those with normal serum sodium levels. Primary reperfusion therapy (thrombolysis/primary PCI) was done in 44.08% of the cases and no signicant association was found between it and outcomes in the hyponatremia group. Complications were present in 23.03% of the cases in hyponatremia group (p &lt;0.05). Mortality was present in 2.64% of the cases and more common in the cases with hyponatremia (p&gt;0.05). The odds of complications (including death) was 2.91 times in the cases with hyponatremia as compared to cases with normal serum sodium levels, 2.47 times in the cases with mild hyponatremia as compared to cases with normal serum sodium levels, 3.42 times in the cases with moderate hyponatremia as compared to cases with normal serum sodium levels and 25 times in the cases severe hyponatremia as compared to cases with normal serum sodium levels. Conclusion: It can be concluded that the severity of MI is more in cases with hyponatremia and hyponatremia is associated with poorer outcomes in terms of complications post MI and mortality.

268 IMPACT OF AORTIC REGURGITATION ON LONG TERM OUTCOME IN HEART FAILURE AND PRESERVED EJECTION FRACTION

Abstract Background Aortic Regurgitation (AR) may aggravate the clinical course in patients with heart failure and preserved ejection fraction (HFpEF) by increasing filling pressures and triggering LV remodelling. Objective To assess AR's prevalence and long-term prognostic implications in patients with HFpEF. Methods The study population consisted of 458 consecutive patients (age 77.5 ± 9.2 y, 57.9% females) hospitalized with de novo or worsened HFpEF. Patients with more than moderate aortic and/or mitral valve disease were excluded. Data on cardiovascular death, HF re-hospitalization and their composite (MACE) were collected. Results Out of 309 (67.5%) patients with any AR, 156 (34.0%) and 153 (33.5%) had mild-AR and moderate-AR, respectively. The remaining 149 (32.5%) individuals had no-AR. Patients with versus without AR were significantly older with larger LV and LA volumes and a higher prevalence of diastolic dysfunction (all p &amp;lt; 0.05). During a median follow-up of 33 ± 25 months, a total of 114 patients (24.9%) died from cardiovascular causes, 126 patients (27.5%) were re-hospitalized for HF, while 272 (59.4%) had the composite endpoint (MACE). In multivariable Cox regression analysis, any AR emerged as an only independent predictor of MACE (HR=1.90, 95%CI 1.26–2.87, p=0.002). Mild-AR and Moderate AR increased the risk of MACE by 77% and 92%, respectively, compared to the No-AR. Conclusions In patients with HFpEF, mild-to-moderate AR is highly prevalent, and it seems to identify individuals with worse long-term outcomes. This suggests that even mild AR should be considered a high-risk prognostic marker in patients with HFpEF.

789 USEFULNESS OF NEUTROPHIL-TO-LIMPHOCYTE RATIO AS A PROGNOSTIC BIOMARKER FOR IN-HOSPITAL COMPLICATIONS AND LONG-TERM MORTALITY IN OLDEST OLD STEMI PATIENTS

Abstract Background the neutrophil to lymphocyte ratio (NLR) is an indicator of systemic inflammation and a prognostic marker in patients undergoing percutaneous coronary intervention (PCI) that has been demonstrated to be related to in-hospital complications and long-term mortality in patients with ST segment elevation myocardial infarction (STEMI). Aims to assess the correlation between NLR and in-hospital complications and mortality, as well as long-term mortality in a population of oldest old (i.e. &amp;gt;85 years old) STEMI patients. Methods we enrolled every oldest old patient admitted in two Hub hospitals with a diagnosis of STEMI who underwent an invasive strategy (coronary angiography ± percutaneous coronary intervention) between January 2010 and June 2021. Blood samples were performed at the first medical contact (in the emergency room or in the cath-lab according to presentation). Follow-up data were collected with phone calls or with revision of computer registries. In-hospital MACCE was defined as a composite of death, heart failure, in-stent thrombosis, relapsing angina, stroke, BARC 3 to 5 bleedings during hospital stay. Results four hundred fifty-eight patients accessed the Hub hospitals for STEMI during the selected period. Among them, 355 patients were eligible for this analysis. One hundred fifty-five patients (44%) experienced an in-hospital MACCE. Patients with in-hospital MACCE had a significantly higher NLR at baseline (10,2±7,4 vs 7,0±4,7 p&amp;lt;0,001), this was also true when in-hospital mortality was considered per se (11,1±8,3 vs 8,0±5,8 p=0,002). Conclusions in our multicentre registry of oldest old STEMI patients, NLR has demonstrated to be an easy access, useful tool to predict in-hospital MACCE and in-hospital mortality.