Trends In Survivors Research Articles

Ventilation and respiratory outcome in extremely preterm infants: trends in the new millennium.

Ventilation and respiratory care have substantially changed over the last decades in extremely premature neonates but the impact on respiratory health remains largely unclear. To determine changes in respiratory care and disease frequency in extremely premature infants, a retrospective single-centre cohort study of extremely preterm infants was performed. All infants born alive between 24 + 0 and 27 + 6weeks of gestation in 2000-2001 (Epoch 1), 2009-2010 (Epoch 2), and 2018-2019 (Epoch 3) were included. The primary outcome of this study was the incidence of bronchopulmonary dysplasia (BPD, diagnosed according to three different criteria) or death. Secondary outcomes included the usage of different ventilation modes, changes in pharmacotherapy, and the incidence of significant extra-pulmonary morbidities. A total of 184 neonates were included of whom 151 survived until 36weeks of corrected GA (cGA). Oxygen or positive pressure dependence increased over time (26.1%, 41.7%, and 56.1% respectively), with higher adjusted odds in Epoch 3 for the composite outcome "BPD or death" (adjusted odds ratio: 2.55 [95%CI 1.19-5.61]). Severity-based definitions showed increasing trends in survivors only. Time spent on invasive mechanical ventilation was similar throughout the years, but the use of non-invasive ventilation significantly increased in Epoch 3 (32.0 [95%CI 25.0-37.0] vs 27.0 [95%CI 26.0-32.0] vs 53.0 [95%CI 46.0-58.0] days). Moreover, mortality-adjusted rates of severe IVH, NEC, or intestinal perforation and multiple sepsis tended to decrease. Conclusion:In spite of significant clinical advancements and adherence to novel treatment guidelines in our neonatal intensive care unit, the incidence of BPD increased over time. What is Known: •Rates of BPD are stable or increase in population-based studies. • Extremely preterm infants are particularly susceptible to developing BPD. What is New: •Despite increased use of evidence-based corticosteroid administration and early initiation of caffeine, the incidence of BPD has not decreased over the past decade. •Increased usage of non-invasive ventilation is associated with an increase of BPD incidence.

Anthropometric trends in survivors of pediatric solid tumors

Anthropometric trends in survivors of pediatric solid tumors

Evaluation of Albumin Kinetics in Critically Ill Patients With Coronavirus Disease 2019 Compared to Those With Sepsis-Induced Acute Respiratory Distress Syndrome.

This report aims to characterize the kinetics of serum albumin in critically ill patients with coronavirus disease 2019 compared with critically ill patients with sepsis-induced acute respiratory distress syndrome. Retrospective analysis. We analyzed two critically ill cohorts, one with coronavirus disease 2019 and another with sepsis-induced acute respiratory distress syndrome, treated in the New York Presbyterian Hospital-Weill Cornell Medical Center. Adult patients in the coronavirus disease 2019 cohort, diagnosed through reverse transcriptase-polymerase chain reaction assays performed on nasopharyngeal swabs, were admitted from March 3, 2020, to July 10, 2020. Adult patients in the sepsis-induced acute respiratory distress syndrome cohort, defined by Sepsis III criteria receipt of invasive mechanical ventilation and a Pao2/Fio2 ratio less than 300 were admitted from December 12, 2006, to February 26, 2019. None. We evaluated serial serum albumin levels within 30 days after ICU admission in each cohort. We then examined the albumin progression trajectories, aligned at ICU admission time to test the relationship at a similar point in disease progression, in survivors and nonsurvivors. Albumin trajectory in all critically ill coronavirus disease 2019 patients show two distinct phases: phase I (deterioration) showing rapid albumin loss and phase II (recovery) showing albumin stabilization or improvement. Meanwhile, albumin recovery predicted clinical improvement in critical coronavirus disease 2019. In addition, we found a deterioration and recovery trends in survivors in the sepsis-induced acute respiratory distress syndrome cohort but did not find such two-phase trend in nonsurvivors. The changes in albumin associated with coronavirus disease 2019 associated respiratory failure are transient compared with sepsis-associated acute respiratory distress syndrome and highlight the potential for recovery following a protracted course of severe coronavirus disease 2019.

Lipid metabolism changes in patients with severe COVID-19

BackgroundWe investigated the dynamic changes in lipid profiles and their correlations with disease severity and clinical outcome in patients with severe COVID-19. MethodsWe retrospectively reviewed 519 severe COVID-19 patients with confirmed outcomes (discharged or deceased), admitted to the West Court of Union Hospital in Wuhan, China, between 29 January and 8 April 2020. ResultsAltogether, 424 severe COVID-19 patients, including 34 non-survivors and 390 survivors, were included in the final analyses. During hospitalization, low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and apolipoprotein A-I (apoA-I) showed an increasing trend in survivors, but showed a downward trend in non-survivors. The serum concentrations of HDL-C and apoA-I were inversely correlated with C-reactive protein (CRP), length of hospital stay of survivors, and disease severity scores. For in-hospital deaths, the areas under the receiver operating characteristic curves (AUCs) of the ratios of CRP/HDL-C and CRP/apoA-I at admission were 0.84 and 0.83, respectively. Moreover, patients with high ratios of CRP/HDL-C (＞77.39) or CRP/apoA-I (＞72.37) had higher mortality rates during hospitalization (log-rank p < 0.001). Logistic regression analysis demonstrated that hypertension, lactate dehydrogenase, SOFA score, and High CRP/HDL-C ratio were independent predictors of in-hospital mortality. ConclusionsDuring severe COVID-19, HDL-C and apoA-I concentrations are dramatically decreased in non-survivors. Moreover, High CRP/HDL-C ratio is significantly associated with an increase in mortality and a poor prognosis.

Longitudinal hematologic and immunologic variations associated with the progression of COVID-19 patients in China

BackgroundCrucial roles of hematologic and immunologic responses in progression of coronavirus disease 2019 (COVID-19) remain largely unclear.ObjectiveWe sought to address the dynamic changes in hematologic and immunologic biomarkers and their associations with severity and outcomes of COVID-19.MethodsA retrospective study including 548 patients with COVID-19 with clarified outcome (discharged or deceased) from a national cohort in China was performed. Cross-sectional and longitudinal variations were compared and the associations with different severity and outcomes were analyzed.ResultsOn admission, the counts of lymphocytes, T-cell subsets, eosinophils, and platelets decreased markedly, especially in severe/critical and fatal patients. Increased neutrophil count and neutrophils-to-lymphocytes ratio were predominant in severe/critical cases or nonsurvivors. During hospitalization, eosinophils, lymphocytes, and platelets showed an increasing trend in survivors, but maintained lower levels or dropped significantly afterwards in nonsurvivors. Nonsurvivors kept a high level or showed an upward trend for neutrophils, IL-6, procalcitonin, D-dimer, amyloid A protein, and C-reactive protein, which were kept stable or showed a downward trend in survivors. Positive correlation between CD8+ T-cell and lymphocytes count was found in survivors but not in nonsurvivors. A multivariate Cox regression model suggested that restored levels of lymphocytes, eosinophils, and platelets could serve as predictors for recovery, whereas progressive increases in neutrophils, basophils, and IL-6 were associated with fatal outcome.ConclusionsHematologic and immunologic impairment showed a significantly different profile between survivors and nonsurvivors in patients with COVID-19 with different severity. The longitudinal variations in these biomarkers could serve to predict recovery or fatal outcome.

Abstract 606A: Biological predictors and the impact of cancer among African American women

Abstract African American women have a lower incidence of breast cancer yet, they have an overall higher mortality rate compared with women of other racial groups. Furthermore, some African American women are more likely to be diagnosed with breast cancer at an advanced stage when compared to other women and are also more likely to have biomarkers that are estrogen and progesterone receptor negative and have a greater propensity to be diagnosed with variant forms of breast cancer when compared with other women. These aforementioned factors may affect a women's quality of life. While the literature is robust with psychosocial and behavioral factors that contribute to the quality of life that African American women experience; to date, there has been a paucity of empirical data that have investigated the role of biological predictors and its effect on the lives of these women. To that end, the specific aim of this study was to test a model and investigate the role of biological risk factors estrogen receptors (ER), progesterone receptors (PR), triple negative breast cancer, Breast CAncer gene (BRCA1/2), Tumor Protein 53 gene (TP53, p53), age &amp;lt;45, Basal Metabolic Index (BMI), and age of first pregnancy that may affect the quality of life, thus having an impact on the lives of African American breast cancer survivors. These factors are hypothesized as impacting the quality of lives of these women and their families. The Impact of Cancer is defined as negative or positive occurrences/after-effects along the breast cancer continuum. The Impact of Cancer (IOCv2) captures the multidimensional aspect of the cancer experience that is specific for cancer survivors and their quality of life. Methods: As part of a larger cross-sectional study, breast cancer survivors completed a demographic data questionnaire inclusive of biological risk factors and the impact of cancer scale. A multiple linear regression was performed to determine the relationship between the two variables. Utilizing recruitment flyers, support groups and word-of-mouth, we recruited and screened 169 women from breast cancer support groups and community dwellers in Southern and Northern California. One hundred and sixty women were eligible and n=155 participated. Inclusion criteria were women who self-identified as African/Black American, age 25 year or older, diagnosis of breast cancer and at least 1-year post-active treatment. Results: Among the biological predictors, none were statistically significant as predictors of the impact of cancer in the lives of these survivors. The results revealed a trend in survivors who were diagnosed before age 45 (p=.077) that their breast cancer experience had a positive impact on their lives.Conclusion: Understanding biological predictors and the unique interplay of these roles may be necessary along the survivorship trajectory. Additional exploration of psycho social predictors and inclusion of specific moderators may be warranted. Citation Format: Claudia M. Davis. Biological predictors and the impact of cancer among African American women [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 606A.

Cancer and Complementary Therapies: Current Trends in Survivors' Interest and Use.

Background. Cancer survivors use complementary therapies (CTs) for a variety of reasons; however, with interest and use reportedly on the rise and a widening range of products and practices available, there is a need to establish trends in and drivers of interest. We aimed to determine (1) frequencies of use, level of interest, and barriers for 30 specific CTs and (2) whether physical symptoms, perceived stress (PS), or spiritual well-being were related to interest levels. Method. A total of 212 cancer outpatients were surveyed at the Tom Baker Cancer Centre in Calgary, Canada. Results. Overall, up to 75% of survivors already used some form of CTs since their diagnosis. The most highly used were the following: vitamins B12 and D, multivitamins, calcium, and breathing and relaxation exercises. Those who had not used CTs indicated highest interest in massage, vitamin B12, breathing and relaxation, mindfulness-based stress reduction, and antioxidants. The most frequently reported barriers for all CTs were not knowing enough about what a therapy was and not having enough evidence on whether it worked. High PS predicted higher interest for all CTs, but spirituality was not significantly related to any. Physical symptoms, anxiety, and depression were significant predictors of interest for some CTs. Conclusion. These findings provide a blueprint for future clinical efficacy trials and highlight the need for clinical practice guidelines.

Role of first day levels and subsequent trends of serum proteins in acute burns

Objective: To explore the role of first day levels and subsequent trends of serum proteins as prognostic indicators in acute burns. Methods: This prospective observational study was carried on 100 burn patients (18-60 years with 20% to 60% total burned body surface area). Serum albumin, globulin and total protein were estimated on alternate days starting from first day of burn. The first day value and the trend of serial values throughout the clinical course were compared between survivor and non-survivor groups. Results: Mean day 1 serum values of albumin, globulin, and total protein were significantly higher in the survivors compared to non-survivors (P<0.000 1). Univariate logistic regression showed that increase in day one value of serum albumin, globulin and total protein by 10g /L each, significantly decreased risk of mortality by 99.4%, 98.3% and 96.6%, respectively. The serial serum values of albumin, globulin and total protein showed rising and declining trends in survivors and non-survivor respectively. Based on the ROC curve, the cut off values at any point during the course below which the prognosis was poor were 16.0 g/L, 18.0 g/L and 39.0 g/L for albumin globulin and total protein, respectively. Conclusions: The study highlights the prognostic importance of day one value and trend of serum albumin, serum globulin and total protein in acute burns. The trend of serum proteins over the course of burns should be monitored for better patient management.

Secondary Cancers in Hodgkin Lymphoma: A Comprehensive Analysis of Incidence and Trends in Survivors

OBJECTIVES: The impact of treatment modifications including replacement of alkylating agents based regimens and improvement in the practices of radiation oncology on the risk of secondary cancers (SCs) in Hodgkin's lymphoma (HL) survivors is unknown in the United States (U.S.). This study analyzed the trends of secondary cancer risks among the survivors of HL in the U.S.METHODS: The HL patients diagnosed during 1973-2014 were identified from the Surveillance, Epidemiology and End results (SEER) database. Due to differences in the treatment practices in HL, the whole cohort was divided into three time-periods: 1973-1986, 1987-2000 and 2001-2014. We compared the risk of SCs in the HL patients with the risk expected in the U.S. general population over the three study periods.RESULTS: With a follow-up of 23,864 HL survivors for 284,730 person-years (PY), 3260 secondary cancers were diagnosed, with standardized incidence ratio (SIR) of 1.97 (95% CI, 1.9-2.04) which resulted in 56.56 excess cancers per 10,000 person-years. SIR for any SCs in women (SIR 2.17; 95% CI 2.06-2.28) was significantly higher than in the men (SIR 1.84; 95% CI 1.75-1.92). The highest SIRs were observed for AML (SIR, 9.9; 95%CI, 8.3-11.9), NHL (SIR, 5.8; 95% CI, 5.3-6.4) and salivary gland tumors (SIR, 6.04; 95% CI, 4-8.8) while lung cancer (23.6%) and breast cancer (27.4%) contributed most to the excess risk in males and females respectively. The SIR for any SCs was maximum in the period after 15 to 20 years from the diagnosis of HL and remained high for more than 20 years after the diagnosis of HL (SIR for ≥ 20 years, 2.34; 95% CI, 2.19 to 2.5). A statistically significant decrease in the overall SIRs of SCs was observed in HL patients diagnosed during 1987-2000 (SIR 1.82 95% CI 1.72-1.93) and 2001-2014 (SIR 1.66 95% CI 1.51-1.82) as compared to the patients diagnosed in 1973-1986 (SIR 2.24 95% CI 2.13-2.35). (Figure 1) The decline in the overall SIR was mostly due to decline in the digestive tract and breast cancers. The SIRs of most of the other solid tumors and hematological malignancies including individual risks for NHL and AML did not decrease in the more recent study periods. Moreover, the decline in the SIRs of solid tumors was noticed only in the patients age below 60 years old. The female patients diagnosed in the most recent period were at lower risk of developing breast cancers (SIR 0.56 95% CI 0.34-0.86) as compared to the general population. The decline in the risk for secondary cancers was observed only after 10 years from the diagnosis of HL. After making adjustments for age, gender and race, patients diagnosed during 1973-1986 were at 12% higher risk of developing SCs (HR 1.12 95% CI 1.03-1.23 p=0.01) as compared to the patients diagnosed during 1987-2000. The hazard ratio for developing SCs in the patients diagnosed during 2001-2014 was not different from the patients diagnosed during 1987-2000 (HR 1.02 95% CI 0.9-1.2 p=0.74).CONCLUSIONS: Although, the overall risk of secondary cancers in patients with Hodgkin's lymphoma has declined after the modifications in Hodgkin's lymphoma treatment, apart from the digestive tract and breast cancers the risk has not changed significantly at most of the individual sites. The risk of secondary cancers is still 70% higher than the general population and is maximum 15-20 years from the diagnosis of Hodgkin's lymphoma. Thus close follow up with active surveillance for secondary cancers is crucial for the long term survivors of Hodgkin's lymphoma. [Display omitted] DisclosuresAilawadhi:Novartis: Consultancy, Honoraria; Pharmacyclics: Research Funding; Takeda: Consultancy, Honoraria; Amgen: Consultancy, Honoraria.

An observational study of incidence, risk factors & outcome of systemic inflammatory response & organ dysfunction following major trauma.

Background & objectives:Trauma is known to lead to systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS), which is often a cause of late deaths after injury. SIRS and MODS have been objectively measured using scoring systems. This prospective observational study was carried out in a tertiary care hospital in India to evaluate SIRS and MODS following trauma in terms of their incidence, the associated risk factors and the effect on the outcome.Methods:All adult patients with major life- and limb-threatening trauma were included. Patients who died within 24 h, those with severe head injury, known comorbidity, immunocompromised state, on immunosuppressants or pregnancy were excluded. SIRS and MODS scores were recorded after initial management (baseline score), on days 3 and 6 of admission. SIRS was defined as SIRS score of ≥2 and MODS was defined as MODS score of ≥1.Results:Two hundred patients were enrolled. SIRS was noted in 156 patients (78%). MODS was noted in 145 (72.5%) patients. Overall mortality was 39 (19.5%). Both SIRS and MODS scores were significantly associated with age >60 yr, blunt injury, (lower) revised trauma score hypotension on admission and (higher) injury severity score, but not with gender, pre-hospital time or operative treatment.Interpretation & conclusions:Both SIRS and MODS scores were associated with longer Intensive Care Unit (ICU) stay, more ICU interventions and higher mortality. Incidence of MODS was significantly higher in patients with SIRS. Both scores showed rising trend with time in non-survivors and a decreasing trend in survivors. The serial assessment of scores can help prognosticate outcome and also allocate appropriate critical care resources to patients with rising scores.

Dynamic evolution of D-dimer level in cerebrospinal fluid predicts poor outcome in patients with spontaneous intracerebral hemorrhage combined with intraventricular hemorrhage

The risk of mortality in patients with intracerebral hemorrhage (ICH) significantly increases when complicated by intraventricular hemorrhage (IVH). We hypothesize that serial measurement of cerebrospinal fluid (CSF) D-dimer levels in patients with both ICH and IVH may serve as an early marker of IVH severity. We performed a prospective study of 43 consecutive ICH patients combined with IVH and external ventricular drainage placement admitted in our institution from 2005–2006. IVH severity (Graeb score) and fibrinolytic activity were evaluated continuously for 7days using CT scans and CSF D-dimer levels. The primary outcome was 30day mortality. Overall 30day mortality was 26% (n=11), with eight deaths (72.7%) after 3days (D3). Graeb score and CSF D-dimer on admission (D0) were not significantly different between survivors and non-survivors. The temporal profiles of both parameters were distinctly different, with a downward trend in survivors and an upward trend in non-survivors. A mortality rate of 54% was observed between D0–D3 when both scores increased during this interval. In contrast, the mortality was only 4% when both measures decreased during this interval. Early phase (D0–D3) CSF D-dimer or Graeb score change demonstrated high sensitivity of 88% and specificity of 81% when predicting 30day mortality. Early phase CSF D-dimer change in patients with both ICH and IVH is accurate in predicting mortality and may be utilized as a cost-effective surrogate indicator of IVH severity. Serial monitoring of CSF D-dimer dynamic changes is useful for early identification of patients with hematoma progression and poor outcome.