1708P Severe neutropenia (grade 4, Gr4N) as a population-based predictor for adverse clinical outcome of chemotherapy induced neutropenia (CIN)

AbstractThe added value of biomarkers, such as procalcitonin (PCT), C-reactive protein (CRP), and white blood cells (WBC), as adjuncts to clinical risk scores for predicting the outcome of patients with community-acquired pneumonia (CAP) is in question. We investigated the prognostic accuracy of initial and follow-up levels of inflammatory biomarkers in predicting death and adverse clinical outcomes in a large and well-defined cohort of CAP patients.We measured PCT, CRP and WBC on days 1, 3, 5, and 7 and followed the patients over 30 days. We applied multivariate regression models and area under the curve (AUC) to investigate associations between these biomarkers, the clinical risk score CURB-65, and clinical outcomes [i.e., death and intensive care unit (ICU) admission].Of 925 patients with CAP, 50 patients died and 118 patients had an adverse clinical outcome. None of the initial biomarker levels significantly improved the CURB-65 score for mortality prediction. Follow-up biomarker levels showed significant independent association with mortality at days 3, 5, and 7 and with improvements in AUC. Initial PCT and CRP levels were independent prognostic predictors of adverse clinical outcome, and levels of all biomarkers during the course of disease provided additional prognostic information.This study provides robust insights into the added prognostic value of inflammatory markers in CAP. Procalcitonin, CRP, and to a lesser degree WBC provided some prognostic information on CAP outcomes, particularly when considering their kinetics at days 5 and 7 and when looking at adverse clinical outcomes instead of mortality alone.

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Risk stratification of patients with pulmonary embolism based on pulse rate and D-dimer concentration

Thrombosis and Haemostasis ◽

10.1160/th09-04-0229 ◽

2009 ◽

Vol 102 (10) ◽

pp. 683-687 ◽

Cited By ~ 21

Author(s):

Esther R. van Bladel ◽

Roger E. G. Schutgens ◽

Repke J. Snijder ◽

Ellen A. M. Tromp ◽

Martin H. Prins ◽

...

Keyword(s):

Blood Pressure ◽

Pulmonary Embolism ◽

Clinical Outcome ◽

Pulse Rate ◽

Outpatient Treatment ◽

Univariate Analysis ◽

Multivariate Logistic Regression Model ◽

Adverse Clinical Outcome ◽

Acute Pe ◽

D Dimer

SummaryTo enable outpatient treatment of a selected group of patients with pulmonary embolism (PE), insight in the determinants of adverse clinical outcome is warranted. We have identified risk factors for serious adverse events (SAE) within the first 10 days of acute PE. We have retrospectively analysed data of 440 consecutive patients with acute PE. Collected data included age, gender, medical history, blood pressure, pulse rate and D-dimer concentration. The variables associated with SAE in the first 10 days in univariate analysis (p<0.15) have been included in a multivariate logistic regression model (backward conditional, p out>0.10). In 440 patients with acute PE, 20 SAEs occurred in a 10-day follow-up period. Pulse rate ≥100 beats per minute (bpm) (OR, 6.85; 95%CI 1.43–32.81) and D-dimer concentration ≥3,000 µg/ml (OR, 5.51; 95%CI 0.68–44.64) were significantly related to the SAEs. All SAEs were predicted by a pulse rate ≥100 bpm and/or a D-dimer concentration ≥3,000 µg/ml. Older age, gender, history of venous thromboembolism (VTE), heart failure, chronic obstructive pulmonary disease, cancer or a systolic blood pressure < 90 mm Hg had no significant influence on short term SAEs. Pulse rate and D-dimer concentration can be used to identify patients with acute PE, who are at risk for adverse clinical outcome during the first 10 days of hospitalisation. Outpatient treatment of PE-patients with a pulse rate ≥100 bpm and/or a D-dimer concentration ≥3,000 µg/ml has to be discouraged.

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PERIPHERAL ENDOTHELIAL FUNCTION PREDICTS 1-YEAR ADVERSE CLINICAL OUTCOME IN PATIENTS WITH CHEST PAIN HOSPITALIZED IN THE EMERGENCY DEPARTMENT

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(18)30674-0 ◽

2018 ◽

Vol 71 (11) ◽

pp. A133

Author(s):

Michael Shechter ◽

Shlomi Matetzky ◽

Megha Prasad ◽

Nira Koren-Morag ◽

Amir Lerman

Keyword(s):

Emergency Department ◽

Chest Pain ◽

Clinical Outcome ◽

Endothelial Function ◽

Adverse Clinical Outcome

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Clinical outcome following late reperfusion with percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872619886312 ◽

2020 ◽

pp. 204887261988631

Author(s):

Lars Nepper-Christensen ◽

Jacob Lønborg ◽

Dan Eik Høfsten ◽

Golnaz Sadjadieh ◽

Mikkel Malby Schoos ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Clinical Outcome ◽

Primary Percutaneous Coronary Intervention ◽

Symptom Onset ◽

Coronary Intervention ◽

Adverse Clinical Outcome ◽

St Segment Elevation ◽

St Segment ◽

Increased Risk ◽

Percutaneous Coronary

Background: Up to 40% of patients with ST-segment elevation myocardial infarction (STEMI) present later than 12 hours after symptom onset. However, data on clinical outcomes in STEMI patients treated with primary percutaneous coronary intervention 12 or more hours after symptom onset are non-existent. We evaluated the association between primary percutaneous coronary intervention performed later than 12 hours after symptom onset and clinical outcomes in a large all-comer contemporary STEMI cohort. Methods: All STEMI patients treated with primary percutaneous coronary intervention in eastern Denmark from November 2009 to November 2016 were included and stratified by timing of the percutaneous coronary intervention. The combined clinical endpoint of all-cause mortality and hospitalisation for heart failure was identified from nationwide Danish registries. Results: We included 6674 patients: 6108 (92%) were treated less than 12 hours and 566 (8%) were treated 12 or more hours after symptom onset. During a median follow-up period of 3.8 (interquartile range 2.3–5.6) years, 30-day, one-year and long-term cumulative rates of the combined endpoint were 11%, 17% and 25% in patients treated 12 or fewer hours and 21%, 29% and 37% in patients treated more than 12 hours ( P<0.001 for all) after symptom onset. Late presentation was independently associated with an increased risk of an adverse clinical outcome (hazard ratio 1.42, 95% confidence interval 1.22–1.66; P<0.001). Conclusions: Increasing duration from symptom onset to primary percutaneous coronary intervention was associated with an increased risk of an adverse clinical outcome in patients with STEMI, especially when the delay exceeded 12 hours.

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