Re-operation for recurrent intracranial meningioma – is it worth it?

Abstract Aims Meningioma is the commonest primary brain tumour. Despite surgery, meningiomas can recur. Surgery is usually the first line treatment for recurrent meningioma. The aim was to determine the risk factors associated with clinical outcomes (performance status, morbidity, mortality, recurrence) following re-operation for recurrence of intracranial meningioma. Method Retrospective cohort study (1998-2018). Eligible patients had re-operation for local recurrence of a previously operated meningioma. Collected data included baseline clinical and imaging characteristic. Primary outcome measure was performance status after each re-operation. Secondary outcome measures were medical and surgical morbidity, recurrence-free survival (RFS) and overall survival (OS). Results Fifty-eight patients were eligible (38 female, mean age at 1st re-operation 56 years (SD=11.4)). Eleven patients (18.9%) had 2 re-operations and 3 patients (3.4%) had 3 re-operations. Median follow up was 125.5 months (IQR 73-191.5). Median time to 1st recurrence and 1st re-operation were 36.5 (IQR 24.2–79.1) and 43.8 months (IQR 22.9–102.7), respectively. Fifteen patients (25.9%) had worse performance status after 1st re-operation, compared to 6.9% (n=4) after the primary operation (Figure 1). Complication rate was 32.8% (n=19) after the primary operation compared to 46.6% (n=27) after 1st re-operation. At primary operation, there were 29 (50%) grade 1, 26 (44.8%) grade 2, and 1 (1.7%) grade 3 tumours. Median RFS after first re-operation was 68 months (95% CI 45.5-90.5) (figure 2). Median OS was 312 months (95% CI 236.9-387.1) (Figure 3). Post-operative complications were a risk factor for worsened performance status following re-operation (OR 4.91, 95% CI 1.3-18.4). Conclusion Re-operation is associated with a worse performance status and increased risk of complications. Re-operating meningiomas for radiological recurrence without symptoms increases patient morbidity. Shared-care management decision should be made with patients when considering operating for radiological recurrence only.

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P14.66 Re-operation for recurrent meningioma - are we helping patients?

Neuro-Oncology ◽

10.1093/neuonc/noab180.174 ◽

2021 ◽

Vol 23 (Supplement_2) ◽

pp. ii50-ii50

Author(s):

G E Richardson ◽

M A Mustafa ◽

C S Gillespie ◽

S M Keshwara ◽

B A Taweel ◽

...

Keyword(s):

Performance Status ◽

Primary Outcome Measure ◽

Secondary Outcome ◽

Management Decision ◽

Intracranial Meningioma ◽

Surgical Morbidity ◽

Primary Operation ◽

Recurrent Meningioma ◽

Primary Brain Tumour ◽

Increased Risk

Abstract BACKGROUND Meningioma is the commonest primary brain tumour. Despite surgery, meningiomas can recur. Surgery is usually the first line treatment for recurrent meningioma. The aim was to determine the risk factors associated with clinical outcomes (performance status, morbidity, mortality, recurrence) following re-operation for recurrence of intracranial meningioma. MATERIAL AND METHODS Retrospective cohort study (1998–2018). Eligible patients had reoperation for local recurrence of a previously operated meningioma. Collected data included baseline clinical and imaging characteristic. Primary outcome measure was performance status after each reoperation. Secondary outcome measures were medical and surgical morbidity, recurrence-free survival (RFS) and overall survival (OS). RESULTS Fifty-eight patients were eligible (37 female, mean age at 1st re-operation 56.1 years (SD=11.6)). Eleven patients (19.6%) had 2 re-operations and 3 patients (5.4%) had 3 re-operations. Median follow up was 128.5 months (IQR=73–194.5). Median time to 1st recurrence and 1st re-operation were 36.5 (IQR=24.3–81.0) and 43.8 months (IQR=20.3–103.4), respectively. Fifteen patients (26.8%) had worse performance status after 1st reoperation, compared to 5.4% (n=3) after the primary operation. Complication rate was 32.1% (n=18) after the primary operation compared to 48.2% (n=27) after 1st reoperation. At primary operation, there were 29 (51.8%) grade 1, 24 (42.9%) grade 2, and 1 (1.8%) grade 3 tumours. Median RFS after first re-operation was 36.5 months (95% CI 29.3–43.9). Median OS was 312 months (95 % CI 257.8–366.2). Increased number of post-operative complications were a risk factor for worsened performance status following reoperation (OR 2.2 [95% CI 1.1–4.6], P=0.029). CONCLUSION Re-operation is associated with a worse performance status and increased risk of complications. Re-operating meningiomas for radiological recurrence without symptoms increases patient morbidity. Shared-care management decision should be made with patients when considering operating for radiological recurrence only.

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Success of trabeculectomy surgery in relation to cataract surgery: 5-year outcomes

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-312972 ◽

2018 ◽

Vol 103 (10) ◽

pp. 1395-1400 ◽

Cited By ~ 2

Author(s):

Rashmi G Mathew ◽

Sahar Parvizi ◽

Ian E Murdoch

Keyword(s):

Cataract Surgery ◽

Outcome Measure ◽

Primary Outcome Measure ◽

Secondary Outcome ◽

Secondary Outcome Measure ◽

Risk Of Failure ◽

Increased Risk ◽

Significant Difference ◽

Measure Change ◽

Group 2

AimsTo compare success proportions at 5 years in three surgical groups: group 1, trabeculectomy alone; group 2, trabeculectomy followed by cataract surgery within 2 years; and group 3, trabeculectomy performed on a pseudophakic eye.MethodsA retrospective cohort study. 194 eyes of 194 patients were identified with at least 5 years’ follow-up post trabeculectomy (N=85, 60 and 49 in groups 1, 2 and 3, respectively).Main outcome measures1. Primary outcome measure: intraocular pressure (IOP) at 5 years post-trabeculectomy surgery, 2.Secondary outcome measure: change in visual acuity at 5 years.ResultsAt 5 years, the mean IOP (SD) was 12.9 (3.5), 12.5 (4.8) and 12.7 (4.8) mm Hg in groups 1, 2 and 3, respectively. Overall success was almost identical, 58%, 57% and 59% in groups 1, 2 and 3, respectively. There was no significant difference between the groups in terms of percentage IOP reduction, number of medications, proportion restarting medication and reoperation rates at 5 years. Logistic regression for an outcome of failure showed men to be at increased risk of failure OR 1.97 (95% CI 1.10 to 3.52, p=0.02). Nearly 80% of patients retained or improved their vision following their initial trabeculectomy.ConclusionsThe sequence in which surgery is carried out does not appear to affect trabeculectomy function at 5 years, success being similar to trabeculectomy alone. In our study, men may be at increased risk of failure.

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REiNS: Recommendations for Measurement of Attention Outcomes in Preschoolers With Neurofibromatosis

Neurology ◽

10.1212/wnl.0000000000012423 ◽

2021 ◽

pp. 10.1212/WNL.0000000000012423

Author(s):

Bonita P. Klein-Tasman ◽

Kristin Lee ◽

Heather L. Thompson ◽

Jennifer Janusz ◽

Jonathan M. Payne ◽

...

Keyword(s):

Clinical Trials ◽

Rating Scale ◽

Dimensional Change ◽

Neurofibromatosis Type ◽

Primary Outcome Measure ◽

Attention Problems ◽

Developmental Trajectory ◽

Secondary Outcome ◽

Increased Risk ◽

Preschool Aged Children

Children with neurofibromatosis type 1 (NF1) are at increased risk for attention problems. While most research has been conducted with school-aged cohorts, preschool-aged children offer a novel developmental window for clinical studies, with the promise that treatments implemented earlier in the developmental trajectory may most effectively modify risk for later difficulties. Designing research studies around the youngest children with NF1 can result in intervention earlier in the developmental cascade associated with NF1 gene abnormalities. Furthermore, clinical trials for medications targeting physical and psychological aspects of NF1 often include individuals spanning a wide age range, including preschool-aged children. In a prior paper, the REiNS Neurocognitive Subcommittee made recommendations regarding performance-based and observer-rated measures of attention for use in clinical trials and highlighted the need for separate consideration of assessment methods for young children. The observer-rated ADHD Rating Scale – Preschool version is recommended as a primary outcome measure. The NIH Toolbox Flanker, Dimensional Change Card Sort, and List Sort Working Memory tasks and Digits Forward from the Differential Ability Scales – Second Edition (performance-based measures) are recommended as secondary outcome measures. Specific methodological recommendations for inclusion of preschoolers in clinical trials research are also offered.

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Cisplatin (Cis)/etoposide (VP16) compared to cis/irinotecan (CPT11) in extensive-stage small cell lung cancer (E-SCLC): Pharmacogenomic (PG) and comparative toxicity analysis of JCOG 9511 and SWOG 0124

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.7524 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 7524-7524 ◽

Cited By ~ 3

Author(s):

P. Lara ◽

M. Redman ◽

H. Lenz ◽

M. Gordon ◽

T. Shibata ◽

...

Keyword(s):

Genetic Polymorphisms ◽

North American ◽

Performance Status ◽

Japanese Patients ◽

Phase Iii ◽

Significant Survival ◽

Increased Risk ◽

Toxicity Analysis ◽

Grade 3 ◽

And Performance

7524 Introduction: J9511 demonstrated a significant survival benefit for Cis/CPT11 over Cis/VP16 in Japanese patients (pts) with E-SCLC (Noda, et al. NEJM 2002). S0124 is the confirmatory North American phase III trial (accrual completed) using the identical J9511 protocol. We hypothesized that toxicities would differ between North American & Japanese pts due in part to differences in the distribution of genetic polymorphisms involved in chemotherapy metabolism. Methods: Toxicity data were compared among 706 pts enrolled in J9511 & S0124 receiving common treatment using a logistic model adjusted for age, sex, and performance status (PS). Select polymorphisms of the UGT1A1, ABCB1, & OATP genes in genomic DNA were evaluated in 142 pts in S0124 only (67 Cis/CPT11; 75 Cis/VP16). Associations between toxicity & genotype within each arm were assessed using logistic regression. Results: Pt demographics for J9511 & S0124 respectively: Mean age − 61 & 62 years; Male sex − 131 (86%) & 315 (57%); PS 0 − 19 (13%) & 173 (31%); PS>0 − 133 (87%) & 372 (68%). Comparative toxicities (≥ grade 3) are summarized ( table ). PG analysis in S0124 pts: ABCB1 (C3435T) T/T was associated with an increased risk of CPT11 grade 3+ diarrhea (p=0.04) versus C/C and C/T. UGT1A1 (G3156A) A/A was associated with increased risk of CPT11 neutropenia (p=0.009) & leukopenia (p=0.05). UGT1A1*28 TA7, typically associated with increased CPT11 toxicity, was seen in only 4 pts (2 Cis/CPT11; 2 Cis/VP16); thus no correlation was done. No gene tested was associated with VP16 toxicity. Conclusions: Significant differences in treatment-related myelosuppression exist between J9511 and S0124 pt populations. Certain polymorphisms in genes involved in CPT11 metabolism are significantly associated with CPT11 toxicities in S0124. Additional analyses are ongoing. These results support the hypothesis that toxicities may be associated with distribution of genetic polymorphisms. No significant financial relationships to disclose. [Table: see text]

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Factors associated with acute toxicity during chemoradiation therapy for rectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.734 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 734-734

Author(s):

Pooja Monpara ◽

Scott Rice ◽

Talha Shaikh ◽

Jeffrey M. Farma ◽

Elin R. Sigurdson ◽

...

Keyword(s):

Rectal Cancer ◽

Weight Loss ◽

Acute Toxicity ◽

Performance Status ◽

Multivariable Analysis ◽

Rectal Adenocarcinoma ◽

Factors Associated ◽

Increased Risk ◽

Grade 3 ◽

Experienced Grade

734 Background: Acute toxicity may be a factor interfering with receipt of chemoradiation (CRT) therapy for rectal cancer. The purpose of this study was to identify clinical and treatment factors associated with increased acute toxicity in patients receiving CRT therapy for rectal cancer. Methods: We identified patients with rectal adenocarcinoma treated with CRT between 2006-2014 at an NCI-designated cancer center. Patients with metastatic disease or missing treatment information were excluded. Acute toxicity information including weight loss, pain, fatigue, constipation, diarrhea, anorexia, and performance status was extracted from weekly on treatment visit notes. Multivariable logistic regression was used to assess predictors of grade 3+ toxicity using covariates significant on univariable analysis. Results: A total of 148 patients were included with a median age of 59 (range 29-99). The majority of patients were male (55%) and received 5-FU based chemotherapy (82%). During CRT, 35 (24%) patients experienced at least one grade 3+ toxicity: 13 (9%) patients experienced grade 3+ fatigue, 1 (1%) experienced grade 3+ constipation, 11 (7%) experienced grade 3+ diarrhea, 14 (10%) experienced grade 3+ pain, and 11 (7%) experienced grade 3+ anorexia. Eight (5.4%) patients had an ECOG performance status > 3 and 28 (19%) patients had weight loss > 5 lbs during CRT. On multivariable analysis, increased distance from the anal verge (OR 0.78 95% CI 0.636-0.998) was associated with a decreased risk for grade 3+ pain and age > 75 was associated with an increased risk of grade 3+ anorexia (OR 6.07 95% CI 1.067-34.56). Clinical T4 disease was associated with an increased risk of weight loss > 5 lbs (OR 0.17 95% CI 0.100-0.446). On multivariable analysis, there were no factors associated with grade 3+ fatigue, diarrhea, or constipation. There were no factors associated with a decline in performance status to > 3 while on treatment. Conclusions: Our results suggest that rectal cancer patients who are older, have more advanced disease, or with low lying tumors may be at an increased risk for treatment-related toxicity. Identifying predictors of toxicity may allow for tailored interventions to minimize toxicity for these patients.

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Pooled Safety and Efficacy Analysis Examining the Effect of Performance Status on Outcomes in Nine First-Line Treatment Trials Using Individual Data From Patients With Metastatic Colorectal Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2008.20.2879 ◽

2009 ◽

Vol 27 (12) ◽

pp. 1948-1955 ◽

Cited By ~ 100

Author(s):

Daniel J. Sargent ◽

Claus Henning Köhne ◽

Hanna Kelly Sanoff ◽

Brian M. Bot ◽

Matthew T. Seymour ◽

...

Keyword(s):

Colorectal Cancer ◽

Clinical Trials ◽

Combination Therapy ◽

Metastatic Colorectal Cancer ◽

Performance Status ◽

Individual Data ◽

First Line ◽

Increased Risk ◽

All Cause Mortality ◽

Grade 3

Purpose Performance status (PS) is a prognostic factor in patients with metastatic colorectal cancer. Clinical trials typically enroll less than 10% of patients with a PS of 2 (PS2); thus, the benefit of systemic chemotherapy in PS2 patients is uncertain. Patients and Methods Individual data from 6,286 patients (509 PS2 patients) from nine clinical trials were used to compare treatment efficacy by PS. Progression-free survival (PFS), grade ≥ 3 adverse events, 60-day all-cause mortality, overall survival (OS), and response rate (RR) were explored in the full set of nine trials and in the five trials comparing first-line monotherapy with combination therapy. Results Compared with patients with PS of 0 or 1, PS2 patients had significantly higher rates of grade ≥ 3 nausea (8.5% v 16.4%, respectively; P < .0001) and vomiting (7.6% v 11.9%, respectively; P = .006) and 60-day all-cause mortality (2.8% v 12.0%, respectively; P < .0001). PS2 was prognostic for PFS (hazard ratio [HR] = 1.52; P < .0001; median PFS, 7.6 months for PS 0 or 1 v 4.9 months for PS2), OS (HR = 2.18; P < .0001; median OS, 17.3 months for PS 0 or 1 v 8.5 months for PS2), and RR (odds ratio = 0.61; P < .0001; 43.8% for PS 0 or 1 v 32.0% for PS2). The relative benefit and toxicity of experimental versus control treatment and monotherapy versus combination therapy were not different in PS 0 or 1 patients versus PS2 patients. Conclusion In clinical trials, PS2 patients derive similar benefit from superior treatment as patients with PS of 0 to 1 but with an increased risk of toxicities and 12% 60-day mortality. Although current treatment provides benefit, new approaches are required to approach 1-year median survival for PS2 patients.

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P14.58 Efficacy and safety of lomustine versus fotemustine as first and second line treament in relapsed glioblastoma patients

Neuro-Oncology ◽

10.1093/neuonc/noab180.169 ◽

2021 ◽

Vol 23 (Supplement_2) ◽

pp. ii49-ii49

Author(s):

M Domènech ◽

C Fabregat ◽

A Hernández ◽

S del Barco ◽

C Panciroli ◽

...

Keyword(s):

Performance Status ◽

Progression Free Survival ◽

Initial Therapy ◽

Second Line ◽

Treatment Delays ◽

Free Survival ◽

Primary Brain Tumour ◽

Grade 3 ◽

Mild Toxicity

Abstract BACKGROUND Glioblastoma (GB) is the most aggressive primary brain tumour. Despite the survival benefit associated with adjuvant therapy, most of patients (pts) relapse after initial therapy. Nitrosoureas (NU) are the standard treatment at relapse in Europe. Both fotemustine (FM) (Addeo schema) and lomustine (LM) (administered orally every 6 weeks) are used in this context. MATERIAL AND METHODS This retrospective cohort study included pts diagnosed with GB treated with NU at relapse in four Catalonia hospitals from 2010 to 2020. Clinical and pathological data were collected from medical records. We analysed 6months-progression-free survival (6m-PFS), progression-free survival (PFS) and overall survival (OS) from the start of NU to progression or death respectively. Differences in toxicity grade using CTCAE v5.0 were analysed globally as ‘non-toxicity’, ‘mild toxicity (grade 1 or 2)’ and ‘high toxicity (grade 3 or 4)’. RESULTS We identified 236 GB pts with a median age of 58 years old. 29% of the pts presented MGMT promotor methylation and only 3%(n=7) had IDH mutation. After a median follow-up of 20 months, 94% of the pts were dead at the time of the analyses. At first line, 83 pts were treated with FM and 18 with LM. Pts treated with FM had better performance status (PS) than those treated with LM (p=.010). Median PFS was 2 months and 6m-PFS was 12% vs 6% in FM and LM group respectively (p=.87). Median OS was 3 months with LM vs 6 months with FM, with no statistically significant differences even adjusted for prognostic factors (p=.79 HR:0.9 CI 95% 0.41–1.96).At second line, 78 were treated with FM and 24 with LM, no differences between groups. Median PFS was 2 months in both groups and median OS was 3 vs 5 months for pts treated with LM vs FM respectively, with no significant differences. 6m-PFS was 13% for LM vs 0% for the FM group (p=.39).Pts received a mean of 1.7 cycles (every 6 weeks) and 4.1 cycles (every 2 weeks) in LM and FM group, respectively. Thrombocytopenia was the most common serious side-effect, with a higher proportion of grade 1–2 toxicity in the FM group (p=.03) that also required more treatment delays (p=.01). CONCLUSION Despite being retrospective study and a few pts were treated with LM, there were no differences neither in PFS nor in OS in pts treated with LM vs FM at first or second line. Higher G1-2 thrombocytopenia was shown in the FM group probably due to a higher number of hematology samples collected.

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Everolimus (EVE) exposure as a predictor of toxicity (Tox) in renal cell cancer (RCC) patients (Pts) in the adjuvant setting: Results of a pharmacokinetic analysis for SWOG S0931 (EVEREST), a phase III study (NCT01120249).

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.4566 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 4566-4566 ◽

Cited By ~ 1

Author(s):

Timothy W. Synold ◽

Melissa Plets ◽

Catherine M. Tangen ◽

Elisabeth I. Heath ◽

Ganesh S. Palapattu ◽

...

Keyword(s):

Oral Mucositis ◽

Performance Status ◽

Cell Cancer ◽

Dropout Rate ◽

Phase Iii ◽

Pharmacokinetic Analysis ◽

Disease Response ◽

Increased Risk ◽

Grade 3 ◽

Trough Levels

4566 Background: S0931 is assessing recurrence-free survival in RCC pts randomized to receive EVE versus placebo for one year following nephrectomy. To date, there has been a higher than expected dropout rate due to bothersome tox. Previous reports have shown an association between EVE trough levels and both tox and disease response in RCC pts. Therefore, we have assessed EVE trough levels to evaluate the relationship between measured exposure and probability of tox. This analysis has been approved by the DSMC. Methods: Patients received 10 mg daily EVE or placebo for nine 6-week cycles. Pre-dose whole blood samples collected pre-cycle 2 and pre-cycle 3 were analyzed for EVE. Pts with pre-cycle 2 and/or pre-cycle 3 EVE results were used in the analysis. When both trough levels were available, results were averaged. Pts were segregated into quartiles (Q) based on EVE levels and logistic regression was used to model the following adverse event outcomes using EVE trough as a predictor; any grade 3+ tox, grade 2+ triglycerides, grade 2+ hyperglycemia, grade 2+ oral mucositis, grade 2+ rash, and premature stopping of EVE. Hazard and odds ratios were adjusted for age, BMI and performance status. Results: This study reached its accrual goal and closed on 9/15/2016 with 1545 (775 EVE) randomized patients. A total of 386 pts are included in this preliminary analysis. Median EVE trough was 12.8 ng/mL (range 3.1, 75.6) per 10 mg dose. Event rates for tox were: any grade 3+ tox = 46%, grade 2+ triglycerides = 33%, grade 2+ hyperglycemia = 15%, grade 2+ oral mucositis = 34%, grade 2+ rash = 15%, and premature stopping of EVE = 40%. The risk of grade 2+ triglycerides was increased in Q2 and Q3 vs Q1 (OR = 2.95; p = 0.001 and OR = 3.48; p < 0.001). The risk of grade 2+ rash was increased in Q2 and Q4 vs Q1 (OR = 2.95; p = 0.02 and OR = 3.20; p = 0.01). There was also a trend towards an increased risk of any grade 3+ tox in Q3 vs Q1 (OR = 1.72; p = 0.07). Conclusions: This analysis has identified significant associations between EVE exposure and the probability of tox. EVE analysis is ongoing and the final results will be presented. Clinical trial information: NCT01120249.

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Outcomes after cardiac transplantation: a new tertiary centre experience

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.212 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

U Ali ◽

W Pavey ◽

K Slimani ◽

C Merry ◽

R Larbalestier

Keyword(s):

Renal Failure ◽

Acute Rejection ◽

Cardiac Transplantation ◽

Primary Outcome Measure ◽

Secondary Outcome ◽

Cardiac Transplant ◽

Tertiary Centre ◽

Increased Risk ◽

The World ◽

The Mean

Abstract Funding Acknowledgements Type of funding sources: None. Background Our hospital is one of the most remote transplant centres in the world. We evaluated the short- and long-term outcomes after cardiac transplantation at a new Tertiary Centre hospital in Western Australia. Methods A retrospective study of all patients undergoing cardiac transplantation since February 2015 until November 2020 was conducted. De-identified data was collected using hospital medical records and the ANZSCTS database. Primary outcome measure was mortality at any time point and acute rejection. Secondary outcome measures included new renal failure, post-operative blood product use and readmission rate. Results A total of 59 cardiac transplantations were conducted, with the mean age of recipients being 52 (±15) years and the majority being male (64.4%). Ischaemic cardiomyopathy and dilated cardiomyopathy were the most common indications for transplantation, accounting for 71.2% of all transplants. The mean age of donors was 35.29 (±11.11) years with the majority being male (69.5%). There were no mortalities and acute rejection within 3 months of transplant occurred in 16 (27.1%) patients. New renal failure was the most common complication occurring in 16 (27.1%) patients. After multivariate analysis, donor ischaemia time >200minutes was associated with an increased risk of renal failure (OR 1.2, P = 0.044). Conclusions Over a five-year period at a new cardiac transplant centre in one of the most remote locations of the world, we report no mortalities.

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Pulmonary thromboembolism in hospitalised patients with COVID-19: a retrospective national study of patients managed in critical care and ward environments in Scotland

BMJ Open ◽

10.1136/bmjopen-2021-050281 ◽

2021 ◽

Vol 11 (8) ◽

pp. e050281

Author(s):

Michael McGettrick ◽

Alexander MacLellan ◽

Paul McCaughey ◽

Catherine Bagot ◽

Melanie J Brewis ◽

...

Keyword(s):

Critical Care ◽

Hospital Admissions ◽

Pulmonary Thromboembolism ◽

Primary Outcome Measure ◽

Secondary Outcome ◽

National Study ◽

Right Heart ◽

Risk Of Death ◽

Hospitalised Patients ◽

Increased Risk

ObjectivesTo assess for increase in pulmonary thromboembolism (PTE) in hospitalised patients with COVID-19, in both critical care and ward environments.SettingWe reviewed all CT pulmonary angiograms (CTPA) performed in Scotland between 23 March 2020 and 31 May 2020 and identified those with COVID-19 using either classical radiological appearances or positive COVID-19 PCR swab.ParticipantsAll hospitalised patients in Scotland with COVID-19 between 23 March 2020 and 31 May 2020 who underwent a CTPA.Primary outcome measureTo assess if the rate of PTE was increased in those with COVID-19 compared with previously published figures of hospitalised patients.Secondary outcome measuresTo assess the effect of right heart strain or requirement for critical care on mortality.Results3401 CTPAs were reviewed. 192 were positive for PTE in patients with evidence of COVID-19 either real-time PCR swab positive for SARS-CoV-2 (n=104) or having radiological changes consistent with COVID-19 (n=88). The total number of hospital admissions in Scotland between 23rd March 2020 and 31st May 2020 with COVID-19 was 5195. The incidence of PTE during this time was 3.7% in all patients admitted to all hospitals in Scotland with COVID-19 during this period. 475 hospitalised patients were managed in critical care (both level 2 and level 3 care), in whom the incidence of PTE was 6% (n=29). 4720 patients did not require admission to critical care, in whom the incidence of PTE was 3.5% (n=163). There was increased risk of death with right heart strain (25/52 vs 128/140 (p<0.01)) and in critical care (15/29 vs 146/163 (p<0.01)).ConclusionsWe have demonstrated an increased risk of PTE in critical care and ward-based environments. Further studies are required to establish effective prophylactic anticoagulation in this group.

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