Distinct prognostic value of different portal hypertension-associated features in patients with primary biliary cholangitis

Abstract Background Primary biliary cholangitis (PBC) may progress to cirrhosis and clinically significant portal hypertension (CSPH). This study assesses different features of CSPH and their distinct prognostic impact regarding decompensation and survival in patients with PBC. Methods Patients with PBC were identified during a database query of our digital patient reporting system. Results A total of 333 PBC patients (mean age 54.3 years, 86.8% females, median follow-up 5.8 years) were retrospectively assessed and 127 (38.1%) showed features of CSPH: 63 (18.9%) developed varices, 98 (29.4%) splenomegaly, 62 (18.6%) ascites and 20 (15.7%) experienced acute variceal bleeding. Splenomegaly, portosystemic collaterals and esophageal varices were associated with an increased 5-year (5Y) risk of decompensation (15.0%, 17.8% and 20.9%, respectively). Patients without advanced chronic liver disease (ACLD) had a similar 5Y-transplant free survival (TFS) (96.6%) compared to patients with compensated ACLD (cACLD) but without CSPH (96.9%). On the contrary, PBC patients with cACLD and CSPH (57.4%) or decompensated ACLD (dACLD) (36.4%) had significantly decreased 5Y survival rates. The combination of LSM < 15 kPa and platelets ≥ 150G/L indicated a negligible risk for decompensation (5Y 0.0%) and for mortality (5Y 0.0%). Overall, 44 (13.2%) patients died, with 18 (40.9%) deaths attributed to CSPH-related complications. Conclusion In PBC, features of CSPH may occur early and indicate an increased risk for subsequent decompensation and mortality. Hence, regular screening and on-time treatment for CSPH is crucial. Combining LSM and platelets serves as a valuable preliminary assessment, as LSM < 15 kPa and platelets ≥ 150G/L indicate an excellent long-term outcome.

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Serum IgG4 and long term outcome in patients with primary biliary cholangitis treated with ursodeoxycholic acid

Zeitschrift für Gastroenterologie ◽

10.1055/s-0036-1586984 ◽

2016 ◽

Vol 54 (08) ◽

Author(s):

ME Pascu ◽

M Riedel ◽

E Schott ◽

B Wiedenmann ◽

T Berg ◽

...

Keyword(s):

Ursodeoxycholic Acid ◽

Primary Biliary Cholangitis ◽

Term Outcome ◽

Long Term Outcome ◽

Serum Igg4

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Perinatal Care at the Threshold of Viability

PEDIATRICS ◽

10.1542/peds.96.5.974 ◽

1995 ◽

Vol 96 (5) ◽

pp. 974-976

Author(s):

◽

Keyword(s):

Perinatal Care ◽

Survival Rates ◽

Extremely Low Birth Weight ◽

Low Birth Weight Infants ◽

Term Outcome ◽

Long Term Outcome ◽

Obstetric Management ◽

The Cost ◽

The Impact

The survival rate for infants at the threshold of viability has been improving. However, there are insufficient data regarding the cost(s) of initial and ongoing care of these infants and the long-term outcome of survivors. Furthermore, there has been little study of the impact of obstetric management on the survival rates of extremely low birth weight infants and on long-term morbidities. Continued research on these issues is imperative, and physicians need to remain informed of changing statistics.

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Long term outcome of childhood onset headache: A prospective community study

Cephalalgia ◽

10.1177/0333102417727536 ◽

2017 ◽

Vol 38 (6) ◽

pp. 1159-1166 ◽

Cited By ~ 9

Author(s):

Matti Sillanpää ◽

Maiju M Saarinen

Keyword(s):

Young Adulthood ◽

Childhood Onset ◽

Term Outcome ◽

Long Term Outcome ◽

Recurrent Headache ◽

Childhood Migraine ◽

Early School ◽

Increased Risk

Purpose To examine prevalence, course, and long-term outcome of childhood migraine and other headaches. Method Using questionnaires, 1185 children were followed for recurrent headaches at ages seven, 14 and 32 years, respectively. Results At age seven years, 4.0% of the 1185 children (girls 3.7%, boys 4.3%) had migraine and 24% (25%/23%) had nonmigrainous headache. In adulthood, 16% (22%/8%) had migraine and 60% (64%/54%) nonmigrainous headache. Childhood migraine persisted into adulthood in 65% of females and 21% of males, and nonmigrainous headache in 62% and 59%, respectively. After childhood, 17% of females and 7% of males started to have episodes of migraine. No recurrent headache during the follow-up was reported by 11% (6%/16%). In a multivariate analysis, compared with no childhood headache, childhood migraine increased the risk of adulthood migraine by 3.36-fold (95% CI 1.94–5.82) and that of nonmigrainous headache by 1.72-fold (1.14–2.60). Discussion and conclusions Headaches are generally as common in preschool girls as boys. From early school years, headaches steadily increase up to young adulthood, but among boys the prevalence levels off after adolescence. About two thirds of children experienced changes in their headache status during a 25-year follow-up. Any kind of recurrent headache at school entry predicts an increased risk of headache in young adulthood. Special attention should be paid to girls and particularly those girls who have recurrent headache when they start school.

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Predictors for the Immediate and Long-Term Outcome of Avascular Surgical Procedure

Scandinavian Journal of Surgery ◽

10.1177/145749690909800307 ◽

2009 ◽

Vol 98 (3) ◽

pp. 164-168 ◽

Cited By ~ 4

Author(s):

J. Virkkunen ◽

M. Venermo ◽

J. Saarinen ◽

J. Salenius

Keyword(s):

Risk Factors ◽

Risk Factor ◽

High Risk ◽

Predictive Value ◽

Surgical Procedure ◽

Operative Mortality ◽

Survival Rates ◽

Term Outcome ◽

Long Term Outcome

Background and Aims: The ability to predict post-operative mortality reliably will be of assistance in making decisions concerning the treatment of an individual patient. The aim of this study was to test the GAS score as a predictor of post-operative mortality in vascular surgical patients. Material and Methods: A total of 157 consecutive patients who underwent an elective vascular surgical procedure were included in the study. The Cox proportional hazards model was used in analyzing the importance of various preoperative risk factors for the postoperative outcome. ASA and GAS were tested in predicting the short and long-term outcome. On the basis of the GAS cut-off value 77, patients were selected into low-risk (GAS low: GAS < 77) and high-risk (GAS high: GAS > = 77) groups, and the examined risk factors were analyzed to determine which of them had predictive value for the prognosis. Results: None of the patients in the GAS low group died, and mortality in the GAS high group was 4.8% (p = 0.03) at 30 days' follow-up. The 12-month survival rates were 98.6% and 78.6% (p = 0.0001), respectively, with the respective 5-year survival rates of 76.7% and 44.0% (p = 0.0001). The only independent risk factor for 30-day mortality was the renal risk factor (OR 20.2). The combination of all three GAS variables(chronic renal failure, cardiac disease and cerebrovascular disease), excluding age, was associated with a 100% two-year mortality. Conclusions: Mortality is low for patients with GAS<77. For the high-risk patients (GAS> = 77), due to its low predictive value for death, GAS yields limited value in clinical practice. In cases of patients with all three risk factors (renal, cardiac and cerebrovascular), vascular surgery should be considered very carefully.

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Long-term outcome of patients with steroid-refractory acute severe UC treated with ciclosporin or infliximab

Gut ◽

10.1136/gutjnl-2016-313060 ◽

2017 ◽

Vol 67 (2) ◽

pp. 237-243 ◽

Cited By ~ 57

Author(s):

D Laharie ◽

A Bourreille ◽

J Branche ◽

M Allez ◽

Y Bouhnik ◽

...

Keyword(s):

Initial Treatment ◽

Survival Rates ◽

Similar Efficacy ◽

Long Term Results ◽

Term Outcome ◽

Long Term Outcome ◽

Free Survival ◽

Steroid Refractory

ObjectiveCiclosporin and infliximab have demonstrated short-term similar efficacy as second-line therapies in patients with acute severe UC (ASUC) refractory to intravenous steroids. The aim of this study was to assess long-term outcome of patients included in a randomised trial comparing ciclosporin and infliximab.DesignBetween 2007 and 2010, 115 patients with steroid-refractory ASUC were randomised in 29 European centres to receive ciclosporin or infliximab in association with azathioprine. Patients were followed until death or last news up to January 2015. Colectomy-free survival rates at 1 and 5 years and changes in therapy were estimated through Kaplan-Meier method and compared between initial treatment groups through log-rank test.ResultsAfter a median follow-up of 5.4 years, colectomy-free survival rates (95% CI) at 1 and 5 years were, respectively, 70.9% (59.2% to 82.6%) and 61.5% (48.7% to 74.2%) in patients who received ciclosporin and 69.1% (56.9% to 81.3%) and 65.1% (52.4% to 77.8%) in those who received infliximab (p=0.97). Cumulative incidence of first infliximab use at 1 and 5 years in patients initially treated with ciclosporin was, respectively, 45.7% (32.6% to 57.9%) and 57.1% (43.0% to 69.0%). Only four patients from the infliximab group were subsequently switched to ciclosporin. Three patients died during the follow-up, none directly related to UC or its treatment.ConclusionsIn this cohort of patients with steroid-refractory ASUC initially treated by ciclosporin or infliximab, long-term colectomy-free survival was independent from initial treatment. These long-term results further confirm a similar efficacy and good safety profiles of both drugs and do not favour one drug over the other.Trial registration numberEudraCT: 2006-005299-42; ClinicalTrials.gouv number: NCT00542152; post-results.

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Superiority of temozolomide over radiotherapy for elderly patients with RTK II methylation class, MGMT promoter methylated malignant astrocytoma

Neuro-Oncology ◽

10.1093/neuonc/noaa033 ◽

2020 ◽

Vol 22 (8) ◽

pp. 1162-1172 ◽

Cited By ~ 6

Author(s):

Antje Wick ◽

Tobias Kessler ◽

Michael Platten ◽

Christoph Meisner ◽

Michael Bamberg ◽

...

Keyword(s):

Promoter Methylation ◽

Methylation Status ◽

Predictive Biomarker ◽

Copy Number Variations ◽

Mgmt Promoter Methylation ◽

Prognostic Impact ◽

Term Outcome ◽

Long Term Outcome ◽

Mgmt Promoter

Abstract Background O6-methylguanine DNA-methyl transferase (MGMT) promoter methylation status is predictive for alkylating chemotherapy, but there are non-benefiting subgroups. Methods This is the long-term update of NOA-08 (NCT01502241), which compared efficacy and safety of radiotherapy (RT, n = 176) and temozolomide (TMZ, n = 193) at 7/14 days in patients >65 years old with anaplastic astrocytoma or glioblastoma. DNA methylation patterns and copy number variations were assessed in the biomarker cohort of 104 patients and in an independent cohort of 188 patients treated with RT+TMZ-containing regimens in Heidelberg. Results In the full NOA-08 cohort, median overall survival (OS) was 8.2 [7.0–10.0] months for TMZ treatment versus 9.4 [8.1–10.4] months for RT; hazard ratio (HR) = 0.93 (95% CI: 0.76–1.15) of TMZ versus RT. Median event-free survival (EFS) [3.4 (3.2–4.1) months vs 4.6 (4.2–5.0) months] did not differ, with HR = 1.02 (0.83–1.25). Patients with MGMT methylated tumors had markedly longer OS and EFS when treated with TMZ (18.4 [13.9–24.4] mo and 8.5 [6.9–13.3] mo) versus RT (9.6 [6.4–13.7] mo and 4.8 [4.3–6.2] mo, HR 0.44 [0.27–0.70], P < 0.001 for OS and 0.46 [0.29–0.73], P = 0.001 for EFS). Patients with glioblastomas of the methylation classes receptor tyrosine kinase I (RTK I) and mesenchymal subgroups lacked a prognostic impact of MGMT in both cohorts. Conclusion MGMT promoter methylation is a strong predictive biomarker for the choice between RT and TMZ. It indicates favorable long-term outcome with initial TMZ monotherapy in patients with MGMT promoter-methylated tumors primarily in the RTK II subgroup.

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Impact of the Total Number of Carotid Plaques on the Outcome of Ischemic Stroke Patients with Atrial Fibrillation

Journal of Clinical Medicine ◽

10.3390/jcm8111897 ◽

2019 ◽

Vol 8 (11) ◽

pp. 1897 ◽

Cited By ~ 1

Author(s):

Hyungjong Park ◽

Minho Han ◽

Young Dae Kim ◽

Joonsang Yoo ◽

Hye Sun Lee ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Intima Media Thickness ◽

Major Adverse Cardiovascular Events ◽

Stroke Patients ◽

Term Outcome ◽

Long Term Outcome ◽

Increased Risk ◽

Prognostic Utility

Background: Atrial fibrillation (AF) shares several risk factors with atherosclerosis. We investigated the association between total carotid plaque number (TPN) and long-term prognosis in ischemic stroke patients with AF. Methods: A total of 392 ischemic stroke patients with AF who underwent carotid ultrasonography were enrolled. TPN was assessed using B-mode ultrasound. The patients were categorized into two groups according to best cutoff values for TPN (TPN ≤ 4 vs. TPN ≥ 5). The long-term risk of major adverse cardiovascular events (MACE) and mortality according to TPN was investigated using a Cox hazard model. Results: After a mean follow-up of 2.42 years, 113 patients (28.8%) had developed MACE and 88 patients (22.4%) had died. MACE occurred more frequently in the TPN ≥ 5 group than in the TPN ≤ 4 group (adjusted hazard ratio [HR], 1.50; 95% confidence interval [CI], 1.01–2.21; p < 0.05). Moreover, the TPN ≥ 5 group showed an increased risk of all-cause mortality (adjusted HR, 2.69; 95% CI, 1.40–5.17; p < 0.05). TPN along with maximal plaque thickness and intima media thickness showed improved prognostic utility when added to the variables of the CHAD2DS2-VASc score. Conclusion: TPN can predict the long-term outcome of ischemic stroke patients with AF. Adding TPN to the CHAD2DS2-VASc score increases the predictability of outcome after stroke.

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Influence of more extensive radiotherapy and adjuvant chemotherapy on long-term outcome of early-stage Hodgkin's disease: a meta-analysis of 23 randomized trials involving 3,888 patients. International Hodgkin's Disease Collaborative Group.

Journal of Clinical Oncology ◽

10.1200/jco.1998.16.3.830 ◽

1998 ◽

Vol 16 (3) ◽

pp. 830-843 ◽

Cited By ~ 191

Author(s):

L Specht ◽

R G Gray ◽

M J Clarke ◽

R Peto

Keyword(s):

Hodgkin's Disease ◽

Randomized Trials ◽

Early Stage ◽

Hodgkin’S Disease ◽

Survival Rates ◽

Collaborative Group ◽

Mortality Data ◽

Term Outcome ◽

Long Term Outcome

PURPOSE To assess the effect of more extensive radiotherapy and of adjuvant combination chemotherapy on long-term outcome of early-stage Hodgkin's disease. METHODS In a collaborative worldwide systematic overview, individual patient data were centrally reviewed on 1,974 patients in eight randomized trials of more versus less extensive radiotherapy and on 1,688 patients in 13 trials of radiotherapy plus chemotherapy versus radiotherapy alone. Crude mortality data on 226 patients in two other trials of chemotherapy were also reviewed. RESULTS More extensive radiotherapy reduced the risk of treatment failure (resistant or recurrent disease) at 10 years by more than one third (31.3% v 43.4% failures; P < .00001), but there was no apparent improvement in overall 10-year survival (77.1 % v 77.0% alive). The addition of chemotherapy to radiotherapy halved the 10-year risk of failure (15.8% v 32.7%; P < .00001), with a small, nonsignificant improvement in survival (79.4% v 76.5% alive). This involved a reduction of borderline significance for deaths from Hodgkin's disease (12.3% v 15.4% dead at 10 years; P = .07), which was partly counterbalanced by a nonsignificant excess of deaths from other causes (12.4% v 10.0% 10-year risk). CONCLUSION More extensive radiotherapy fields or the addition of chemotherapy to radiotherapy in the initial treatment of early-stage Hodgkin's disease had a large effect on disease control, but only a small effect on overall survival. Recurrences could be prevented by more extensive radiotherapy or by additional chemotherapy. However, if chemotherapy had not been given initially, recurrences were generally salvageable by re-treatment with chemotherapy. Hence, less intensive primary treatment--particularly a reduction in radiotherapy fields--appears to achieve similar survival rates as more intensive treatment, although more randomized evidence is needed to confirm this.

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Long-term outcome and psychiatric comorbidity of adolescent-onset anorexia nervosa

Clinical Child Psychology and Psychiatry ◽

10.1177/1359104519827629 ◽

2019 ◽

Vol 25 (1) ◽

pp. 33-44 ◽

Cited By ~ 7

Author(s):

Susana Andrés-Pepiñá ◽

Maria Teresa Plana ◽

Itziar Flamarique ◽

Sonia Romero ◽

Roger Borràs ◽

...

Keyword(s):

Anorexia Nervosa ◽

Control Group ◽

Term Outcome ◽

Long Term Outcome ◽

Statistical Manual ◽

Diagnostic And Statistical Manual ◽

Increased Risk ◽

A Current

Objective: To assess the outcome of adolescents with anorexia nervosa (AN) about 20 years after first treatment. Methods: Sixty-two women diagnosed with AN during adolescence were invited to participate. Of these 62 patients, 38 agreed to participate and were assessed with a battery of questionnaires and interviews. A control group of 30 women of similar age was also assessed. Results: Of the patients who completed the full assessment, 13 (34%) presented some degree of eating disorder (ED) at follow-up (10 (26%) met full Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) criteria for an ED and 3 (8%) showed partial remission of an ED). The remaining 25 (66%) patients had fully recovered from AN. The duration of untreated illness before admission was significantly associated with an increased risk of a current ED (odds ratio (OR) = 3.334 (1.3–8.7); p = .014). Of the patients who had recovered totally from their ED, 24% showed another psychiatric disorder. This percentage rose to 70% in patients with a current ED. Conclusion: Sixty-six percent of adolescents who completed the assessment achieved remission of their AN. Comorbidity was more common in the current ED group. The variable that best predicted complete remission was the number of years without treatment, showing the importance of detection and early intervention.

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