Term Outcome Of Patients Research Articles

Long Term Outcomes in Patients With Differences in Sex Development in Lucknow, India.

The long term outcomes for individuals with a difference in sex development (DSD) are influenced by ethnic, socio-cultural and economic factors, besides the medical issues. Data from India on these aspects are sparse. We report on gender identity, patients' opinion regarding timing of genitalia surgery, suicidal thoughts, romantic inclination, and quality of life (QOL, SF36 scale), in 31 young adults with a DSD. Median (IQR) age was 23 (19-27) years; 16 raised male, 15 female. Age at first surgery was 6.0 (2.0-16.25) years. Gender identity in 30 patients remained identical with sex of rearing. Majority (27) thought the timing of genital surgery should be in childhood. Six of 31 patients had attempted suicide at least once. Four patients reported sexual abuse in the past. Twelve patients reported romantic relationships, rates similar to reports from India, with seven reporting sexual intercourse. Eleven of 31 patients reported aversion to and fear of sexual activity, due to fear of rejection. Heterosexual orientation was reported by 25 of 29 patients. QOL scores were not different between patients and 46 healthy controls or 43 people with type 1 diabetes. Mental QOL scores were lower for those with history of teasing (37.10 ± 16.01 vs. 47.76 ± 9.4 in those without, p = 0.04) and with suicidal thoughts (33.9 ± 14.51 vs. 45.65 ± 13.2 for those without, p = 0.04). The absence of prominent gender dysphoria in our young adults was noteworthy, as was their preference for early genital surgery. Lack of adequate mental health support is a high alert for our teams involved in the care of DSD and as well as for policy-makers.

Long term outcomes of patients with decompensated aortic stenosis undergoing urgent transcatheter aortic valve implantation: a TAVI-NOR subs-study

Abstract Background Aortic stenosis (AS) is a progressive disease, which untreated leads to irreversible myocardial damage and potentially death. Patients with AS may present with acute decompensation (ADAS) even during active surveillance. Purpose In this TAVI-NOR sub-study, we investigate the clinical profile, risk factors, epidemiology and long-term outcomes of patients treated with TAVI after presenting with ADAS compared to stable patients who underwent elective TAVI (no ADAS). Method A total of 600 patients with severe AS consecutively treated with TAVI between January 2012 and July 2019 were enrolled in TAVI-NOR study. Predictors and long-term clinical outcomes were explored in binary logistic and Cox regression models. Results A total of 68 patients (11.3%) received urgent TAVI due to acute hospitalization with ADAS. Age (80±8.0 years vs 81±6.0 years, p=0.662), gender (56% males vs 50% males, p=0.361) and other comorbidities at baseline such as cardiovascular disease, chronic lung disease and atrial fibrillation (AF) were comparable in patients with ADAS and no ADAS (n=532) (p>0.05 for all). However, patients with ADAS had greater symptom burden (NYHA III-IV 81% vs 51%, p<0.001), lower blood pressure, higher heart rate and lower estimated glomeruli filtration rate (52.0±10.8 vs 54.6±9.8 mL/min/1.73m2, p<0.045). They had also higher prevalence of ECG left ventricular (LV) hypertrophy (40% vs 27%, p=0.027), more often reduced LV ejection fraction (<50%) (41% vs 16%, p<0.001), lower stroke volume (39±11 ml/m2 vs 42±11 ml/m2 vs, p=0.030) a trend of abnormal ECG (p=0.055) and longer hospital stay (11.5 ±8.7 days 6.6± 4.9 days, p<0.001). Patients with ADAS were comparable with no ADAS in terms of early short-term (<30 days) all-cause mortality (p>0.05). Although 1-year mortality was comparable (1.5% in ADAS vs 2.1% in no ADAS, p>0.99), mid- to late-term mortality rates were significantly higher in patient with ADAS receiving urgent TAVI, with 3-, 5- and 7 years mortality of 22% vs 11%, p=0.008; 46% vs 29%, p=0.005; 53% vs 39%, p=0.033, respectively. In a Kaplan-Meier analysis, event-free survival was significantly reduced for patients with ADAS undergoing urgent TAVI compared with stable patients undergoing elective TAVI HR 1.63, 95% CI 1.15-2.31, p=0.006), confirmed by a multivariable-adjusted model (HR 1.54; 95% CI 1.05-2.25, p=0.026) independent of age, gender, AF, LV ejection fraction and time from diagnosis to TAVI (Fig). Conclusion Patients with AS presenting with acute decompensation and treated with urgent TAVI had excellent short-term survival. This was irrespective of increased symptom burden, adversely remodeled and functionally reduced LV at baseline. These findings might explain the observed higher mid- and long-term mortality compared with stable patients undergoing elective TAVI. It is essential to identify patients at risk of acute decompensation and treat them timely before irreversible myocardial damage occur.

Outcomes and Complications of Image-Guided Percutaneous Tumour Ablation for Hepatocellular Carcinoma at the Irish National Liver Transplant Centre.

Background: Image-guided tumour ablation is a minimally invasive treatment for early stage hepatocellular carcinoma (HCC). Our study reviews the complications and long term outcomes in patients treated at a tertiary referral centre. Methods: Retrospective study. All patients with HCC who underwent microwave ablation (MWA) or radiofrequency ablation (RFA) from 1st January 2014 to 31st December 2022 were identified. Treatment response of target lesion, complications, and survival were recorded. Results: One hundred seventy ablations were performed in 118 patients; 70% MWA, 30% RFA. Median radiological follow-up 21 months (range 3-107). Follow-up imaging was reported using LI-RADS and mRECIST. At first follow-up imaging, 94 patients had complete response (primary efficacy rate 80.3%) while 19.7% (n = 23) had residual disease. Fifteen of these had repeat ablation; 10 had complete response (secondary efficacy rate 85.6%). By end of study duration, 70.5% (n = 79) achieved sustained local complete response from single ablation without documented recurrence. 14.3% (n = 16) required more than one ablation of target lesion. Overall, 84.8% (n = 95) demonstrated long term local complete response to ablation. Complication occurred in 5.9% (n = 10); 40.0% Grade I, 40.0% Grade II, 10.0% Grade III, 10.0% Grade IV as per the CIRSE Classification. 1-, 3-, and 5-year overall survival (OS) rate was 97%, 68%, and 61% respectively. Mean OS was 5.3 years (median 4.7). No difference in OS (P = .7) or local progression free survival (P = .5) between patients treated with MWA versus RFA. Conclusion: This study demonstrates excellent long-term response to TA, with acceptable complication profile. No difference in survival between RFA versus MWA.

Long term outcomes in patients with advanced intrahepatic cholangiocarcinoma treated with hepatic arterial infusion chemotherapy.

Hepatic artery infusion (HAI) of chemotherapy has demonstrated disease control and suggested improvement in overall survival (OS) in intrahepatic cholangiocarcinoma (IHC). We report herein the long-term results and role of molecular alterations of a phase II clinical trial of HAI chemotherapy plus systemic chemotherapy, with a retrospective cohort of patients treated with HAI at Memorial Sloan Kettering Cancer Center. This secondary analysis of a single-institution, phase 2 trial and retrospective cohort of unresectable IHC treated with HAI floxuridine (FUDR) plus systemic gemcitabine and oxaliplatin. The primary aim was to assess long-term oncologic outcomes. A subset underwent tissue-based genomic sequencing, and molecular alterations were correlated with progression-free survival (PFS) and OS. Thirty-eight patients were treated on trial with a median follow up of 76.9 months. Median PFS was 11.8 months (95% CI11-15.1). The median OS was 26.8 months (95% CI20.9-40.6). The 1-, 2- and 5-year OS rate was 89.5%, 55%, and 21% respectively. Nine (24%) received HAI with mitomycin C post FUDR progression with an objective response rate of 44% and a median PFS of 3.93 (2.33-NR) months. One-hundred and seventy patients not treated on the clinical trial were included in a retrospective analysis. Median PFS and OS was 7.93 (95%CI: 7.27-10.07) and 22.5 (95%CI : 19.5-28.3) months, respectively. Alterations in the TP53 and cell-cycle pathway had a worse PFS to HAI based therapy compared to wildtype disease. In locally advanced IHC, HAI with FUDR in combination with systemic therapy can offer long term durable disease control. Molecular alterations may predict for response.

Association of Fragmented QRS Complex with Short Term Outcome in Patients with Acute ST-Elevation Myocardial Infarction

Background: Acute ST-elevated myocardial infarction is a life-threatening condition. Presence of fragmented QRS (fQRS) after acute STEMI is associated with alteration of myocardial activation due to myocardial scar and myocardial fibrosis. Previous studies have suggested that fQRS in acute STEMI is associated with increased mortality, morbidity, sudden cardiac death and recurrent adverse cardiovascular events. The study was designed to assess the association of fQRS complex with short-term outcome (in hospital and 30 days follow up) in patients with acute ST elevation myocardial infarction. Methods: This prospective cohort study was conducted in the Department of Cardiology, Dhaka Medical College Hospital among the STEMI patients who were thrombolysed. All patients underwent serial ECG at admission, within first 12 hours, at 24 hours and at 48 hours for detecting the presence of fQRS complex. Patients showing fQRS involving infarct territory within 48 h of admission were included in the “fQRS group” and those who did not develop fQRS within 48 h of admission were included in the “without fQRS” group. 114 patients had fQRS complex and 104 patients were without fQRS in their ECG. In-hospital outcomes such as: death, heart failure, significant arrhythmias (VT, VF AF, SVT, 20 AV block, CHB), cardiogenic shock were recorded. Among the study patients, sixteen patients were lost to follow up in 30 days of index hospitalization. Finally, 202 patients were tracked for follow up regarding death or re hospitalization information by personal contact or over telephone. Statistical analysis was performed using the statistical package for social science (SPSS) 21.0 software for windows. Results: Appearance of fQRS complex occurred at admission, within first 12 hours, 24 hours and 48 hours in 53.5%, 23.7%, 14.9% and 7.9% cases respectively. During index hospitalization, development of cardiogenic shock (27.19% vs 11.54%), heart failure (23.68% vs 9.62%) and significant arrhythmias were significantly higher in fQRS group (42.10% vs 11.53%, p<0.05). Although mean duration of hospitalization was similar in both groups (p>0.05), but in-hospital mortality was higher in fQRS group (11.40% vs 3.85%, p<0.05). Rate of re-hospitalization was significantly higher in patients with fQRS complex (21.69% vs 7.29% p<0.05). Overall mortality within 30 days of index hospitalization follow-up also differs significantly in presence of fQRS complex (19.81% vs 5.2%; p =0.006). Conclusion: Presence of fQRS complex is associated with adverse short-term outcome in patients with acute ST elevation myocardial infarction. Hence, these patients need more aggressive and early invasive treatment to reduce morbidity and mortality. Bangladesh Heart Journal 2024; 39(2); 93-101

Number needed to treat with intravenous tenecteplase to reduce the need for mechanical thrombectomy in large vessel occlusion acute ischemic stroke patients: A retrospective look at real-world experience data

ObjectiveWe sought to describe short term outcomes in patients with large vessel occlusion acute ischemic stroke (LVOAIS) who were treated with intravenous tenecteplase (TNK) as compared to alteplase (tPA), focusing on reduction in the need for mechanical thrombectomy (MT). BackgroundIn LVOAIS, TNK has shown improved reperfusion and outcomes with a similar safety profile to tPA. Ultra-early reperfusion has been described with TNK which would prevent the need for MT. We analyze the magnitude of this effect in a “real-world” setting. Design/MethodsIn this retrospective study, demographic, clinical, and imaging information from patients with LVOAIS treated with intravenous thrombolysis was collected. Data was compared between the group treated with TNK and tPA. ResultsOne hundred eighty-six patients met the criteria for the study. Of these,144patients received tPA and 42 received TNK. Nine had clinical improvement prior to groin puncture and did not require angiography.When combining the number of patients who had recanalization on angiography before MT and those who had clinical improvement prior to angiography, there were a total of 23 patients. This was noted in 9.7 % of patients who received tPA and 21.4 % of those who received TNK (p = 0.043). For patients treated with TNK we observed a rapid clinical improvement, improved NIHSS, improved functional outcomes and decreased length of stay compared to patients treated with tPA. For patients with spontaneous recanalization either angiographically or with clinical improvement from intravenous thrombolysis, MT may not be required. ConclusionsIntravenous TNK in patients with LVOAIS decreases the need for MT, and is associated with improved outcomes and reduced length of stay.

Long term outcomes in patients with recurrent/metastatic (R/M) salivary gland cancer (SGC) treated with immune checkpoint inhibitors (ICI).

e18063 Background: There is no standard of care systemic therapy in R/M SGC. Regimens containing ICIs are of interest, but overall response rates (ORRs) are low, and median duration of response (mDOR) and long term overall survival (OS) data are limited. We pooled mature data from two clinical trials evaluating the use of ICIs in SGC to evaluate long term outcomes. Methods: We combined the results of two phase I/II, open label, single arm trials utilizing ICIs in R/M SGC. NCT02538510 administered pembrolizumab 200 mg IV q3 weeks and vorinostat 400 mg PO 5 days on/2 days off. NCT03749460 administered nivolumab 3mg/kg IV q2 weeks x 12 doses, followed by 480 mg IV q4 weeks x 8 doses and ipilimumab 1 mg/kg IV q6 weeks x 4 doses with hypofractionated radiotherapy at 1-5 metastatic sites to a total dose of 24Gy/3 fractions over 1 week initiated 2 weeks after immunotherapy. All patients were ≥18 years with R/M disease, evidence of progression within 3 months of study entry, measurable disease per RECIST 1.1, EGOG PS 0-1, and adequate organ function at enrollment. PDL1 expression was not required for participation and prior ICI was not allowed. ORRs were evaluated by RECIST 1.1. OS and progression free survival (PFS) were estimated via the Kaplan-Meier method. Results: 45 patients were enrolled in the two studies from 11/2015-5/2022. The combined median age was 57 (IQR 46, 66). 26 (57.8%) were male; 33 (73.3%) were white and 10 (22.2%) were Asian. 27 (60.0%) had an ECOG PS of 0. Most common histology types were adenoid cystic carcinoma (21, 46.7%), acinic cell carcinoma (5, 11.1%), and salivary duct carcinoma (5, 11.1%). The ORR was 17.8% with all responders having a PR (n=8, histology types: 3 acinic cell, 2 adenoid cystic, 1 adenocarcinoma, 1 salivary duct, 1 lymphoepithelioma-like carcinoma). 20 (44.4%) had SD, with 16 (80.0%) of these responses lasting greater than 6 months. 16 (35.6%) had PD. One patient was not evaluable for RECIST due to rapid disease progression and death. At analysis, median follow up was 29.2 months (IQR 27.1-50.0) among survivors, mDOR was 26.7 months (range 7.1-69.5+), with three patients with ongoing response. Median OS and PFS were 25.4 (95% CI 14, 43.2) and 6.2 months (95% CI 3.9, 15.5) respectively. 23 (51.1%) patients received systemic therapy after trial ICI. Patients received: 4 additional ICI (3 PD-1 monotherapy, 1 ipi/nivo), 5 androgen deprivation therapy, 5 chemotherapy, 9 other treatments (dabrafenib/trametinib, everolimus, fam-trastuzumab deruxtecan, osimertinib, lenvatinib, investigational agents). Conclusions: Although SGC is heterogenous, responses to ICI were observed in multiple subtypes and were durable, similar to observations in other solid tumors. A significant proportion received subsequent lines of therapy post ICI, and exploration of ORR and PFS to next lines of therapy is of interest. Clinical trial information: NCT02538510 and NCT03749460 .

Long term outcomes of patients with advanced/unresectable melanoma treated with immune checkpoint inhibitors.

e21518 Background: Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of advanced/unresectable melanoma. There is a need for long term follow up of patients (pts) treated with ICIs in the real world to evaluate durability of response and facilitate follow-up care. Methods: Pts ≥ 18 years (y) old with advanced/unresectable melanoma who received ≥ 1 cycle of ICI at BC Cancer between 2012 and 2022 were identified using the BC Cancer Registry and pharmacy databases. Best overall response of complete response (CR), partial response (PR), stable disease (SD) or progressive disease (PD) was obtained from CT and PET reports. Oligo-progression that was successfully treated with local therapy was not considered true progression. Results: In total 530 pts were identified. The median follow up for alive pts was 65 months (m) (range 1.4 – 150 m); the median age was 66 y (range 21 – 98). The majority were male (63%) and Caucasian (91%), with ECOG performance status 0 (38%) or 1 (48%). Primary tumour origin was cutaneous (n = 390, 74%), mucosal (n = 36, 7%), ocular (n = 47, 9%) or unknown (n = 57, 11%). BRAF V600 mutations (mut) were identified in 35% of pts (40% cutaneous/unknown). Pts either received PD-1 inhibitor alone (PD-1i) (n = 242, 46%), combination ipilimumab and nivolumab (ipi/nivo) (n = 136, 26%), ipilimumab alone (ipi) (n = 83, 16%) or sequential use of ipi and PD-1i (sequential) (n = 69, 13%). Overall survival (OS) was superior in cutaneous/unknown (5 y 34.5%) compared with mucosal (5 y 28%) and ocular (5 y 5%) primaries (p < 0.001). Excluding ocular cases for the ensuing analyses, by treatment group (ipi/nivo, PD-1i, ipi, sequential) the 5 y OS was 43%, 36%, 37% and 10%, respectively (p < 0.001). Pair-wise comparison of ipi/nivo vs PD-1i favored ipi/nivo (OS p = 0.059) despite a greater proportion of pts with M1d disease (24% vs 15%; p = 0.012). The benefit of ipi/nivo was more pronounced in pts < 65 y (5 y OS 45% vs 36%; p = 0.07), but less clear in pts ≥ 65 y (5 y OS 40% vs 36%; p = 0.385). An OS benefit was observed with ipi/nivo in pts with BRAF wild-type disease (5 y 47.5% vs 33%, p = 0.018 (cutaneous/unknown only, p = 0.021) but not in patients with BRAFmut positive disease (5 y 38% vs 41.5%, p = 0.989). Those treated with ipi/nivo vs PD-1i had numerically higher rates of CR (37% vs 26%), though pts who achieved a CR with either ipi/nivo or PD-1i had a similar 5 y OS (88% vs 96%; p = 0.285). To minimize guarantee-time bias, a 1 y landmark analysis was performed for those treated with ipi/nivo and PD-1i, excluding pts that died during the first year. 5 y OS differed significantly by response (CR, PR, SD, PD) to both ipi/nivo (86%, 36.5%, 42%, 8%; p < 0.001) and PD-1i (90.5%, 35%, 16%, 19%; p < 0.001). Conclusions: Overall, pts treated with ipi/nivo have the best long-term outcomes. However, outcomes are similar in pts treated with PD-1i who have a CR. Further, in older pts and pts with BRAFmut positive disease the benefit of ipi/nivo over PD-1i is less clear.

Long term outcome of patients with rectal cancer with complete clinical response or near complete clinical response after neoadjuvant therapy: A multicenter registry study by Chinese Watch and Wait Database.

e15597 Background: To report the long-term outcomes of Chinese rectal cancer patients after Watch and Wait (W&W) following neoadjuvant therapy(NAT). Methods: Collecting real-world multicenter retrospective data, including the Chinese W&W Database group (CWWD) and data from centers that initiated this work earlier in China. Patients with a follow-up time of no less than 2 years were included. Analyzing and reporting on their oncological outcomes and comparing differences between cCR and near-cCR groups. Results: The study included 318 rectal cancer patients from 8 institutions who received NAT and underwent W&W. Among them, 291 initially achieved cCR, and 27 had near-cCR. The median follow-up time was 48.4 months (10.2-110.3 months). The 5-year OS and CSS were 92.4% (95% CI 86.8-95.7%) and 96.6% (95% CI 92.2-98.5%), respectively. The 5-year OP-DFS(organ preservation adapted DFS) was 86.6% (95% CI 81.0-90.7%), and the 5-year OPR was 85.3% (95% CI 80.3-89.1%). The overall 5-year local regrowth rate and distant metastasis rate were 18.5% (95% CI 14.9-20.8%) and 8.2% (95% CI 5.4-12.5%), respectively. The 5-year local regrowth rate in the near-cCR group was higher than in the cCR group (41.6% vs. 16.4%, p<0.01), with a lower OPR rate (69.2 vs. 88.0%, p<0.001). However, there were no significant differences in OS, CSS, and OP-DFS between the two groups. 91% of local regrowths occurred within the intestinal lumen, 7.2% (4/56) occurred simultaneously in the intestinal lumen and mesentery, and 1.8% (1/56) occurred only in the mesentery. 82.1% of local regrowths occurred within 2 years, 91.0% occurred within 3 years, with a median regrowth time of 11.7 months (2.5-66.6 months). Among cases with local regrowth beyond 2 years, 30% (3/10) had mesenteric regrowth. The salvage success rate after local regrowth (conversion to disease-free status after salvage surgery) was 82.1% (46/56). 60.8% of distant metastases occurred within 2 years, 73.9% occurred within 3 years. Common sites included lung metastasis (65.2%), liver metastasis (34.8%), and bone metastasis (30.4%), with 26% involving multiple organs. 83.3% (5/6) of liver metastases occurred within 2 years, while lung and bone metastases spread out over 5 years follow-up. Among patients with local regrowth, 16.0% (9/56) developed distant metastases. The salvage success rates for local regrowth and distant metastasis were 82.1% (46/56) and 12.5% (3/23), respectively. Conclusions: Rectal cancer patients who achieve cCR or near-cCR after NAT and undergo W&W have favorable oncological outcomes and a high rate of organ preservation. Local regrowth and distant metastasis during W&W follow certain patterns, with a relatively high salvage rate for local regrowth. It emphasizes the importance of close follow-up and timely intervention during the W&W process.

#2012 Long term outcomes in patients with primary membranous nephropathy: a retrospective cohort study from a single center

Abstract Background and Aims Membranous nephropathy (MN) is one of the most common causes of nephrotic syndrome in non-diabetic adults, accounting for almost 30% of biopsy-diagnoses. The degree of proteinuria varies widely from sub-nephrotic (less than 3.5 g/day) to more than 20 g/day. Patients with primary MN who attain either spontaneous or treatment-induced remission, generally, have a good long-term prognosis. Those who reach partial remission fare better than those with stable or progressive disease, while duration of remission- whether spontaneous or due to treatment is linked to better renal outcomes. This study aims to study long-term outcomes in MN patients, identifying risk factors of relapse and treatment non-responsiveness. Method The retrospective cohort study included 40 patients, with available data, diagnosed with primary MN between 2013 and 2023. Data on urinary protein to creatinine ratio (UPCR), serum albumin, estimated glomerular filtration rate (e-GFR), anti-PLA2R-Antibodies (PLA2R-Ab), CD19+ subpopulations, and lipid profile were collected, alongside treatment types over five years. Baseline date was defined as the date of renal biopsy, primary renal diagnosis, or symptom onset. We defined complete remission, partial remission, and relapse based on UPCR: complete remission as a UPCR of less than 300 mg/g, partial remission as a UPCR of less than 3.5 g/g provided there is also a 50% or greater reduction from the baseline UPCR, and relapse as a UPCR greater than 3.5 g/g after a period in which complete or partial remission was achieved. We monitored patients for clinical signs of remission, relapse, and non-response to treatment. Logistic regression was used to identify risk factors for remission and relapse. Additionally, a survival analysis was conducted with the primary endpoint being time to a 40% reduction in e-GFR. Results The mean age at baseline was 55.5 ± 13.2 years, with 70% being men. Mean proteinuria was 11 ± 7.5 g/g, with 75% presenting with nephrotic syndrome, while 34% of them had positive anti-PLA2R Ab. Baseline e-GFR was 75 ± 30.5 ml/min/1.73 m2. 15% (6/40) of patients did not require immunosuppressive treatment and experienced spontaneous remission. 44% (18/40) of total patients received treatment with Rituximab, 35% (14/40) received treatment with modified ponticelli regimen, while the remaining 2 patients required more than 2 different treatments to achieve remission. Complete remission was achieved by 42% of the patients, 41% achieved only partial remission, while the rest 17% did not attain remission. Relapse occurred in 32% of the patients, requiring further immunosuppressive therapy. Positive anti-PLA2R Ab (exp (B) = 15.1 p-value = 0.031) and male gender (exp (B) = 2, =.3 p-value = 0.01) were associated with higher risk of non-response to treatment. Over a follow-up of 5 years, patients with partial remission had a 26-fold times increased risk of relapse (p-value = 0.023,) compared to those with complete remission. Higher baseline UPCR also correlated with an increased relapse risk; a 1g/g increase in UPCR raised relapse risk by 17% (p-value = 0.016, exp (B) = 1.174). Kaplan-Meier survival curves demonstrated that patients achieving any form of remission did not experience the endpoint of 40% reduction in e-GFR (log-rank p-value = 0.007). Conclusion These analyses indicate that achieving and maintaining remission in primary MN is key for preserving e-GFR and preventing kidney progression. Risk factors like male gender, initial heavy proteinuria, and positive PLA2R antibodies need special attention and careful management to optimize patient outcomes.

Impact of clinical frailty scale on short and long term outcome in patients with acute coronary syndrome

Abstract Funding Acknowledgements None. Background As recently outlined in the European Society of Cardiology (ESC) guidelines on acute coronary syndrome (ACS), scarce data still exits about the prognostic role of frailty to guide clinical decision-making for patients with ACS. Purpose To assess the potential predictive value of frailty both for short, and long term all-cause mortality, in a contemporary ACS population. Methods All consecutive admissions due to ACS, from 01/01/2019 to 31/12/2021, were retrospectively reviewed from an internal database of a tertiary cardiac center in Salerno (Italy). Logistic and Cox proportional regression analysis were performed in order to assess the contribution of frailty on 30-days and long term mortality. Frailty was assessed using the Clinical Frailty Scale (CFS) and patients were classified as non frail (CFS 1-4), and frail (CFS 5-9). Both logistic and Cox regression analysis were adjusted for age, gender, GRACE risk score, comorbidity burden, defined by the Charlson comorbidity score (CCS), and all other relevant covariates associated with outcomes of interest in the univariate analysis. In order to estimate the survival rates during the follow-up, a Kaplan Meyer analysis was carried out and differences between the CFS groups were assessed using the log-rank test. Robustness of the results were assessed through an internal validation procedure with bootstrapping. All statistical analyses were performed using SPSS software version 25.0 (SPPS Inc., Chicago, Illinois) and R version 4.0.5 (R Foundation for Statistical Computing, Vienna, Austria). A p-value of less than 0.05 was considered significant. Results 1366 patients were identified. The median age was 68 (58-77). Of these patients, 1087 (79,6%) were classified as non-frail (CFS 1-4), and 279 (20,4%) as frail (CFS 5-9). 120 (8,8%) and 140 (11,2%) deaths occurred, respectively, during the first 30 days from admission, and during long term follow-up (median follow-up time: 15 months; IQR: 10-24). After multivariate regression analysis the CFS was associated with both short and long-term mortality (OR: 1,6, 95% CI: 1,34-1,91; p<0,001 and HR: 1,37, 95% CI: 1,18-1,58; p<0,001, Fig. 1). Patients with CFS ≥ 5 showed significant higher mortality rate during long term follow-up (p<0.001; Fig.2). Conclusions The CFS is a strong predictor of both short and long-term mortality in patients affected by ACS also after comprehensive adjustment for baseline differences in other risk factors.Fig. 2

Association of Admission CRP Level with Short Term Outcome in Patients with Acute Ischemic Stroke

Acute ischemic stroke is very common in Bangladesh and one of the most common causes of physical disability and death. This study was performed to determine the prognostic value of CRP measured in the very early phase of ischemic stroke for short term functional outcome of patients with acute ischemic stroke. This observational study was carried out in the departments of Medicine and Neurology of Faridpur Medical College Hospital, Faridpur from July 2012 to December 2012. Total 100 patients of acute ischemic stroke were recruited in this study. Blood sample was collected for CRP level during the time of admission. In this study 26% of patients were in low CRP group (CRP <3 mg/L), 34% of patients were in medium CRP group (CRP 3-9.9 mg/L), 40% of patients were in high CRP group (CRP ≥10 mg/L). According to modified Rankin Scale (mRS) scoring system the high CRP group having a 44% risk for a poor outcome (mRS ≥3 ) vs 27% for the low CRP group ( p = 0.01). According to Barthel Index (BI) scoring system the high CRP group having a 45% risk for a poor outcome (BI <95) vs. 25% for the low CRP group (p = 0.002). Z test of proportion revealed significant association between high CRP level and poor short-term outcome of patients with acute ischemic stroke. Bangabandhu Sheikh Mujib Med. Coll. J. 2024;3(1):12-15

Value of Immature Granulocyte in Prediction of Severity of Coronary Artery Disease and Short Term Outcome in Patients with Ischemic Heart Disease

Value of Immature Granulocyte in Prediction of Severity of Coronary Artery Disease and Short Term Outcome in Patients with Ischemic Heart Disease

Circulating Osteopontin Predicts Clinical and Radiological Response in First-Line Treatment of Advanced Non-Small Cell Lung Cancer

PurposePembrolizumab-based regimens are conditioned by the expression of PD-L1, but durable response rate is limited by innate and acquired resistance mechanisms. Here, we focus on osteopontin (OPN), an upfront biomarker of senescence, which closely associated with natural history of non-small cell lung cancer (NSCLC).MethodsSeventy-nine patients eligible to pembrolizumab regimens—alone or in combination with chemotherapy—as first-line treatment of advanced NSCLC were enrolled. Predictive value of OPN toward iRECIST progression disease (PD) was set as first outcome. Secondary ones included performance status (ECOG) at baseline, early (first and best) responses, and overall survival (OS).ResultsHigh Serum OPN characterized patients with worse ECOG-PS (p = 0.015) at baseline and subjects experienced PD/death at first (OR 1.17 [1.02 to 1.35]; p = 0.030) and best responses (0.04 [0.00 to 0.81]; p = 0.035). OPN was associated with time-to-progression (B -2.74 [−4.46 to −1.01]) and time-to death (−0.13 [−0.20 to −0.05]). Cox regression models unveil a predictive value for iRECIST-PD (HR 1.01 [1.00 to 1.02]; p = −0.005), RECIST-PD (HR 1.01 [1.00 to 1.02]; p = 0.017), and OS (HR 1.02 [1.01 to 1.03]; p = 0.001). These models were internally validated through bootstrap resampling and characterized by relevant discrimination ability at ROC curve analyses.ConclusionBaseline levels of serum OPN is closely associated with performance status and short/long term outcomes in patients with advanced NSCLC, which are candidate to pembrolizumab-based regimens. As upfront biomarker of senescence, OPN may pave the way for future studies focusing on senescence patterns in NSCLC.

Role of lactate level in predicting admission need to intensive care unit and short term outcomes in patients with acute gastrointestinal bleeding

Abstract Background One of the most common emergencies seen in emergency departments is acute gastrointestinal bleeding (GIB). It’s associated with more disease burden and mortality. Increased venous lactate levels are common in critically ill patients, and it has been used as a possible predictor of patients’ outcomes in many critical cases, but not much is known about its predictive role in patients with acute GIB. With increasingly limited health care resources, there has been such an interest in coast saving measures and measuring lactic acid through venous blood gases is such a simple bedside test which can be easily done to patients with acute GIB at emergency department. Objective This study assessed the predictable value of lactate level on hospital admission on resource use, including length of hospital stay and admission to the intensive care unit (ICU), as well as other patient-oriented outcomes, including the need for blood transfusions and endoscopy. Patients and methods A prospective cohort hospital based study that included 300 patients with acute GIB who presented to emergency department (ED) of Assiut University Hospital between September 2019 and June 2022 were subjected to venous blood lactate through venous blood gases. Results The current study enrolled 300 patients with acute GIB. Two hundred of those patients had elevated blood lactate and 100 patients had normal blood lactate. It was found that patients with elevated blood lactate had significantly prolonged hospital stay (7.38 days ± 2.05 days vs. 3.96 days ± 1.74 days; (P < 0.001). Also they had higher frequency of blood transfusion (98% vs. 72%), ICU admission (95% vs. 67%) and mortality (9% vs. 3%) in comparison to those with normal lactate level. Conclusion It was found that venous lactate level is an effective predictor for patient’s outcomes among patients with acute GIB.

Supervised Exercise Therapy for Intermittent Claudication: A Propensity Score Matched Analysis of Retrospective Data on Long Term Cardiovascular Outcomes

This study aimed to explore the long term outcomes of patients with intermittent claudication (IC) who completed supervised exercise therapy (SET) vs. those who declined or prematurely discontinued SET, focusing on the incidence of chronic limb threatening ischaemia (CLTI), revascularisation, major adverse limb events (MALE), and major adverse cardiovascular events (MACE). A retrospective registry analysis of consecutive patients with IC who were referred for SET between March 2015 and August 2016 and followed up for a minimum of five years. Serial univariable analysis and logistic regression were performed to identify the statistically significant clinical variables that were independent predictors of each outcome measure. The resulting statistically significant variables were used to guide 1:1 propensity score matching (PSM) using the nearest neighbour method with a calliper of 0.2. Cox proportional hazards regression was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) for the association between SET and the outcomes of interest. Two hundred and sixty-six patients were referred to SET between March 2015 and August 2016. Of these, 64 patients completed SET and 202 patients did not. After PSM, 49 patients were analysed in each cohort. The Cox proportional hazards analysis revealed a significant association between completion of SET and revascularisation requirement (HR 0.46 95% CI 0.25 - 0.84; p= .011), completion of SET and progression to CLTI (HR 0.091, 95% CI 0.04 - 0.24; p < .001), completion of SET and MACE (HR 0.52; 95% CI 0.28 - 0.99; p= .05) and completion of SET and MALE (HR 0.28, 95% CI 0.13 - 0.65; p= .003). The Harrell's C index for all of these models was greater than 0.75, indicating good predictive accuracy. Completion of SET is associated with better outcomes in patients who completed SET compared with patients who declined or discontinued SET with respect to clinically important cardiovascular outcomes over seven years.

Implementation of a high sensitivity cardiac troponin I assay and risk of myocardial infarction or death at five years: observational analysis of a stepped wedge, cluster randomised controlled trial

ObjectiveTo evaluate the impact of implementing a high sensitivity assay for cardiac troponin I on long term outcomes in patients with suspected acute coronary syndrome.DesignSecondary observational analysis of a stepped...

Worse long term prognosis in new onset HFpEF treated in HF clinics compared to HFrEF and HFmrEF patients; reflecting need for effective treatment in HFpEF. Results from the Stockholm PREFERS Study

Abstract Background/Introduction Few contemporary studies are available for long term outcome in patients with new onset heart failure (HF) of the three 3 phenotypes; HF with preserved ejection fraction (HFpEF), mildly reduced (HFmrEF) and reduced EF (HFrEF). The Stockholm PREFERS study (Preserved and Reduced Ejection Fraction Epidemiological Regional Study) included new onset HF patients between 2014-18. Purpose To report and compare long term outcomes for patients with new onset HFpEF, vs HFmrEF and HFrEF. Methods Totally 547 patients, HFpEF n = 137 (25%), HFmrEF n = 61 (11%) and HFrEF n = 349 (64%) were included and followed to end of August 2021. Time to total and cardiovascular (CV) mortality and CV mortality and first HF hospitalizations were compared by log rank test and Cox regression models. All patients were followed at hospital-based HF clinics for guideline directed information and treatment. HFpEF patients were recommended optimal treatment for comorbidities including hypertension, diabetes, ischemic heart disease and atrial fibrillation, and RAAS-inhibition or diuretics. Primary endpoint: CV mortality and HF hospitalizations. Results Mean age was 76 (HFpEF), 71 (HFmrEF) and 67 (HFrEF) years (p&amp;lt;0.001). Female sex 49% (HFpEF), 30% (HFmrEF) and 30% (HFrEF) (p&amp;lt;0.001). Median follow up was 3.8 years (IQR 3.0;4.7). Median EF was 55%, 45% and 30% in HFpEF, HFmrEF, and HFrEF, respectively (p&amp;lt;0.001). All-cause mortality was 13% (n = 70), and CV mortality 7.3% (n = 40). The overall CV hospitalization rate was 13.9% (n = 76). The combined endpoint of CV mortality and HF hospitalizations was 21.2% (n = 116) and higher in HFpEF compared to HFrEF (Univariate Hazard ratio (HR) 2.3 (95% CI 2.0-2.5, p&amp;lt;0.001) and vs HFmrEF (HR 2.5; 2.1-2.6, p&amp;lt;0.001). In analysis adjusted for age, sex and diabetes, HFpEF had worse outcome vs HFrEF and HFmrEF (HR 1.5; 0.2-2.0, p&amp;lt;0.05). Conclusions New onset HFpEF patients have worse long term outcome vs new onset HFrEF and HFmrEF patients. There is a need for effective evidence based treatment in HFpEF.Figure 1

Abstract 12884: Impact of an Addiction Consult Team on the Management and Outcomes of Patients With Surgically Managed Drug Use Associated Infective Endocarditis

Background: Recurrent injection drug use is a major driver of poor long term outcomes in patients who undergo surgery for drug use associated infective endocarditis (DUA-IE). The effect of an inpatient addiction consult team (ACT) on this population is not well described. Methods: To assess the impact of an ACT on DUA-IE patients, we performed a single center retrospective review of all adults who underwent surgery for active DUA-IE and survived to discharge (DC) between 2012-2022 at a large academic teaching institution. An ACT was established in 9/2017. We compared measures of substance use disorder (SUD) care, readmission, reinfection, and death pre- and post- ACT implementation using logistic regression models. Results: The pre- and post-ACT groups were similar at baseline (Table 1). In a univariate analysis, post-ACT patients were more likely to receive medications for opiate use disorder (MOUD) pre-operatively, to receive MOUD at DC, and to have MOUD follow up appointments scheduled at DC. They were less likely to receive non-MOUD opiates at DC or to be readmitted at 30 or 90 days. Overall rates of SUD follow up care scheduled prior to DC were low. There were no differences in harm reduction measures, recurrent IE, or death. In a multivariate analysis, the association of the ACT with decreased 90 day readmissions remained significant (Table 2). Conclusion: Among surgically managed DUA-IE patients, ACT implementation was associated with improved metrics of SUD care and readmissions at 90 days, but not recurrent IE or death. Future efforts should focus on strengthening harm reduction interventions and ensuring SUD follow up to sustain longitudinal engagement in care.

Do Patients who Undergo Fixation for Pilon Fracture Develop Symptoms Comparable to Primary Ankle OA?

Category: Ankle Arthritis Introduction/Purpose: Pilon fractures are challenging to manage and have poor functional outcomes and high complication rates. A significant proportion of these patients go on to develop post-traumatic ankle arthritis. Our aim was to assess the long term patient reported outcomes following pilon fracture fixation and how this compares to patients with end stage ankle osteoarthritis requiring surgical intervention in the form of total ankle arthroplasty. Methods: We retrospectively identified all patients who underwent pilon fracture fixation between April 2012 and December 2015 (Group A). Group B consisted of patients with primary ankle osteoarthritis awaiting elective total ankle replacement between 2015 and 2017. Patients completed a Patient Reported Outcome Measures questionnaire (MOX-FQ, EQ-5D and FAOS scores) pre and post-operatively. The average follow up was 8 years. Results: There were 18 patients in Group A and 22 in Group B. Ankle arthritis patients reported significantly worse score for MOXFQ Pain (P vs. AA; 39.0 ±29.5 vs. 68.0 ±27.1; p=0.001), Difficulty with Walking/ Standing (38.3±26.0 vs. 56.4±26.5; p=0.037) and difficulty with social activities (24.0 ±25.6 vs. 49.4 ±31.3; p=0.007) and FAOS domains of symptoms (68.7 vs. 52.1; p=0.005), ability to do Activities of Daily Living (18.9 vs. 27.5; p= 0.003) and Quality of life (56.6 vs. 32.5; p=0.012). There was no difference between groups for EQ-5D general health scores (78.8 vs. 68.8; p=0.156). Ankle arthritis group patients reported worse scores for mobility, ability to self-care and performed activities of daily living (p=0.012) compared to the pilon fracture group. Conclusion: Our 8 year follow up demonstrate good long term outcomes for patients following pilon fracture fixation. Patients did not develop symptomatic arthritis comparable to end stage ankle arthritis requiring surgical intervention and we therefore recommend primary treatment with fixation, irrespective of fracture severity.