2211. Impact of Early Fiberoptic Bronchoscopy on Microbiological Diagnostic Rate and Clinical Outcomes of Pneumonia in Acute Leukemia Patients

Abstract Background Fiberoptic bronchoscopy with BAL (FOB) remains the cornerstone in the diagnosis of pneumonia in immunocompromised patients; however, there is no uniform agreement on the best timing for FOB, and its impact on microbiological diagnostic rate and clinical outcome has not been established. Methods Retrospective study (October 2017–December 2017, July 2018–January 2019) at MD Anderson Cancer Center. The medical records of adult patients with AML, MDS or ALL who developed pneumonia (CAP, HCAP, HAP excluding VAP) and underwent FOB were reviewed. By definition, patients who underwent FOB within 48 hours after the diagnosis of pneumonia were categorized as early FOB group. We compared demographic, clinical, microbiological data, and outcomes between two groups. Data were analyzed via χ 2, Fisher’s exact and Wilcoxon rank-sum test and logistic regression. Results Of 140 patients included, 33 patients (24%) had early FOB and 107 patients (76%) had late FOB. There was no significant difference between two groups in demographic features, radiological findings, ANC and pneumonia severity index. Microbiological diagnostic rate of FOB did not differ between early FOB and late FOB: identification of pathogenic microorganisms (33.3% vs. 36.5%, p = 0.837), bacteria (6.1% vs. 13.1%, P = 0.36), fungi (18.2% vs. 12.2%, P = 0.39) and respiratory virus (12.1% vs. 16.8%, P = 0.6), respectively (Figures 1 and 2). On univariate analysis, the duration of intravenous antibacterial therapy was shorter in early FOB, with a median duration of 8.5 days (IQR 6.5–12) in early FOB and 11 days (IQR 8–18) in late FOB (P = 0.0047) (Figure 3). Multivariable logistic regression analysis showed that late FOB (OR 3.26, 95% CI 1.41 to 7.53, P = 0.0057) and negative bacterial culture on FOB (OR 3.06, 95% CI 1.01 to 9.22, P = 0.048) were significantly associated with longer duration of intravenous antibacterial therapy (≥10 days). There was no significant difference in ICU admission, 30-day and 60-day mortality and re-admission rate. Conclusion Early FOB was associated with shorter duration of intravenous antibacterial therapy for pneumonia in acute leukemia patients, which has an important impact on both optimization of antimicrobial therapy for patients and improvement of antimicrobial stewardship. Disclosures All authors: No reported disclosures.

Download Full-text

Abstract 14559: Prognostic Utility of Cardiac Markers in Covid-19 Patients

Circulation ◽

10.1161/circ.142.suppl_3.14559 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Ahmad Damati ◽

Kok Hoe Delcos Chan ◽

Iyad Farouji ◽

Amr Al-ramahi ◽

Patel Bhavic ◽

...

Keyword(s):

Logistic Regression ◽

Univariate Analysis ◽

Cardiovascular Complications ◽

Hospitalized Patients ◽

Multivariable Logistic Regression Analysis ◽

Cardiac Markers ◽

Significant Difference ◽

The Us ◽

Prognostic Utility ◽

Artery Disease

Introduction: SARS-CoV-2 infection has been associated with a multiple cardiovascular complications. It is not known if cardiac markers can be used for outcome prediction in the US population. Methods: We conducted a retrospective study on patients ≥ 18 years old with confirmed COVID 19, who were admitted to our hospital between 03/15/2020 and 05/25/2020. Individuals were included if they had a baseline troponin and brain natriuretic peptide (BNP) available, and if their outcome by the end of the study period was well defined as discharge alive, or deceased. Univariate and multivariate logistic regression methods were employed to identify the cardiac markers associated with mortality in COVID-19 patients. Results: The total number of confirmed COVID-19 hospitalized patients during the study period was 348, after excluding patients who did not have cardiac markers available, 233 patients were included in the study, 75 (32%) expired, and 158 (68%) were discharged alive. The median age was 65 years old, and ranged from 22 to 101 years old. 140 males and 93 females. Comorbidities were present in 201 (86%) patients, with hypertension (65%) being the most common, followed by obesity (55%), diabetes mellitus (DM) (44%) and coronary artery disease (27%). Mechanical ventilation was required for 61 patients of whom 42 expired. In univariate analysis, we found a significant difference in history of chronic kidney disease defined by eGFR <45ml/min (p=0.046), DM (p=0.043), initial SOFA (p=0.017), troponin (p=0.001), BNP (p=0.043), CRP (p=<0.0001), LDH (p=<0.0001) and ferritin (p=<0.0001) between survivors and non-survivors. With multivariable logistic regression analysis, the only values that had an odds of survival were a low troponin (odds ratio [OR] 0.17; 95% confidence interval [CI], 0.04-0.52), a low SOFA (OR 0.72, CI 0.50-0.94) and a low CRP (OR 0.87, CI 0.87-0.94). Conclusions: This retrospective cohort study of hospitalized patients with COVID-19 suggests an independent association of increased troponin as risk factor for death in COVID-19 patients. Cardiac troponin has been reported as potential prognostic marker in the China cohort. To our knowledge, we are first to demonstrate the utilization of troponin as mortality predictor in the US population.

Download Full-text

Comparison of laparoscopic and hand-assisted laparoscopic nephrectomy for inflammatory renal disease: which is the preferred approach?

Therapeutic Advances in Urology ◽

10.1177/1756287220984046 ◽

2021 ◽

Vol 13 ◽

pp. 175628722098404

Author(s):

Xudong Guo ◽

Hanbo Wang ◽

Yuzhu Xiang ◽

Xunbo Jin ◽

Shaobo Jiang

Keyword(s):

Logistic Regression ◽

Renal Disease ◽

Complication Rate ◽

Adverse Outcomes ◽

Laparoscopic Nephrectomy ◽

Multivariable Logistic Regression Analysis ◽

Invasive Approach ◽

Intraoperative Complication ◽

Multivariable Logistic Regression ◽

Significant Difference

Aims: Management of inflammatory renal disease (IRD) can still be technically challenging for laparoscopic procedures. The aim of the present study was to compare the safety and feasibility of laparoscopic and hand-assisted laparoscopic nephrectomy in patients with IRD. Patients and methods: We retrospectively analyzed the data of 107 patients who underwent laparoscopic nephrectomy (LN) and hand-assisted laparoscopic nephrectomy (HALN) for IRD from January 2008 to March 2020, including pyonephrosis, renal tuberculosis, hydronephrosis, and xanthogranulomatous pyelonephritis. Patient demographics, operative outcomes, and postoperative recovery and complications were compared between the LN and HALN groups. Multivariable logistic regression analysis was conducted to identify the independent predictors of adverse outcomes. Results: Fifty-five subjects in the LN group and 52 subjects in the HALN group were enrolled in this study. In the LN group, laparoscopic nephrectomy was successfully performed in 50 patients (90.9%), while four (7.3%) patients were converted to HALN and one (1.8%) case was converted to open procedure. In HALN group, operations were completed in 51 (98.1%) patients and conversion to open surgery was necessary in one patient (1.9%). The LN group had a shorter median incision length (5 cm versus 7 cm, p < 0.01) but a longer median operative duration (140 min versus 105 min, p < 0.01) than the HALN group. There was no significant difference in blood loss, intraoperative complication rate, postoperative complication rate, recovery of bowel function, and hospital stay between the two groups. Multivariable logistic regression revealed that severe perinephric adhesions was an independent predictor of adverse outcomes. Conclusion: Both LN and HALN appear to be safe and feasible for IRD. As a still minimally invasive approach, HALN provided an alternative to IRD or when conversion was needed in LN.

Download Full-text

387. Markers for Mortality in COVID-19 Patients with Atrial Fibrillation or Flutter

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.582 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S262-S262

Author(s):

Kok Hoe Chan ◽

Bhavik Patel ◽

Iyad Farouji ◽

Addi Suleiman ◽

Jihad Slim

Keyword(s):

Atrial Fibrillation ◽

Logistic Regression ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Prognostic Markers ◽

Univariate Analysis ◽

Laboratory Data ◽

Significant Difference ◽

New Onset

Abstract Background Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection can lead to many different cardiovascular complications, we were interested in studying prognostic markers in patients with atrial fibrillation/flutter (A. Fib/Flutter). Methods A retrospective cohort study of patients with confirmed COVID-19 and either with existing or new onset A. Fib/Flutter who were admitted to our hospital between March 15 and May 20, 2020. Demographic, outcome and laboratory data were extracted from the electronic medical record and compared between survivors and non-survivors. Univariate and multivariate logistic regression were employed to identify the prognostic markers associated with mortality in patients with A. Fib/Flutter Results The total number of confirmed COVID-19 patients during the study period was 350; 37 of them had existing or new onset A. Fib/Flutter. Twenty one (57%) expired, and 16 (43%) were discharged alive. The median age was 72 years old, ranged from 19 to 100 years old. Comorbidities were present in 33 (89%) patients, with hypertension (82%) being the most common, followed by diabetes (46%) and coronary artery disease (30%). New onset of atrial fibrillation was identified in 23 patients (70%), of whom 13 (57%) expired; 29 patients (78%) presented with atrial fibrillation with rapid ventricular response, and 2 patients (5%) with atrial flutter. Mechanical ventilation was required for 8 patients, of whom 6 expired. In univariate analysis, we found a significant difference in baseline ferritin (p=0.04), LDH (p=0.02), neutrophil-lymphocyte ratio (NLR) (p=0.05), neutrophil-monocyte ratio (NMR) (p=0.03) and platelet (p=0.015) between survivors and non-survivors. With multivariable logistic regression analysis, the only value that had an odds of survival was a low NLR (odds ratio 0.74; 95% confidence interval 0.53–0.93). Conclusion This retrospective cohort study of hospitalized patients with COVID-19 demonstrated an association of increase NLR as risk factors for death in COVID-19 patients with A. Fib/Flutter. A high NLR has been associated with increased incidence, severity and risk for stroke in atrial fibrillation patients but to our knowledge, we are first to demonstrate the utilization in mortality predictions in COVID-19 patients with A. Fib/Flutter. Disclosures Jihad Slim, MD, Abbvie (Speaker’s Bureau)Gilead (Speaker’s Bureau)Jansen (Speaker’s Bureau)Merck (Speaker’s Bureau)ViiV (Speaker’s Bureau)

Download Full-text

Abstract TP50: A Critical Assessment of the Golden Hour and the Impact of Procedural Timing in Stroke Thrombectomy: A Single-Center Study

Stroke ◽

10.1161/str.51.suppl_1.tp50 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Aaron P Wessell ◽

Helio De Paula Carvahlo ◽

Elizabeth Le ◽

Gregory Cannarsa ◽

Matthew J Kole ◽

...

Keyword(s):

Logistic Regression ◽

Mechanical Thrombectomy ◽

Univariate Analysis ◽

Multivariable Logistic Regression Analysis ◽

Procedure Time ◽

Golden Hour ◽

Poor Outcome ◽

Multivariable Logistic Regression ◽

Scale Scores ◽

The Impact

Background: Previous studies have demonstrated the importance keeping thrombectomy procedure times ≤60 min., termed the ‘golden hour’. In the current study, we further investigate the significance of the ‘golden hour’ and the impact of procedural timing on clinical outcomes after mechanical thrombectomy. Methods: We performed an analysis of 319 consecutive mechanical thrombectomy patients at a single Comprehensive Stroke Center from April 2012 through February 2019. Bivariate analyses compared patients grouped according to procedure time ≤60 min. or >60 min. and time of stroke onset-to-endovascular therapy (OTE) ≤6 hours or >6 hours. Logistic regression was used to determine independent predictors of poor outcome at 90-days defined by modified Rankin Scale (mRS) scores of 3-6. Results: A procedure time ≤60 min. was associated with increased revascularization rates (88% vs. 67%; p<0.001) and a greater percentage of good outcomes at 90-days (47% vs. 31%; p=0.003). Multivariable logistic regression revealed that greater age (OR 1.03, 95% CI 1.004-1.051; p=0.023), higher admission NIHSS score (OR 1.10, 95% CI 1.038-1.159; p=0.001), and history of diabetes mellitus (OR 1.94, 95% CI 1.049-3.580; p=0.035) were independently associated with a greater odds of poor outcome. Modified TICI scale scores of 2C (OR 0.12, 95% CI 0.047-0.313; p<0.001) and 3 (OR 0.19, 95% CI 0.079-0.445; p<0.001) were associated with a reduced odds of poor outcome. Although not statistically significant on univariate analysis, OTE ≤6 hrs. was independently associated with a reduced odds of poor outcome (OR 0.41, 95% CI 0.212-0.809; p=0.010) in the final multivariate model (AUC 0.800). Procedure time ≤60 min. did not have a significant independent association with clinical outcome on multivariate analysis (p=0.095). Conclusions: Thrombectomy procedure times beyond 60 min. are associated with lower overall revascularization rates and worse 90 day functional outcomes when compared to faster thrombectomy procedures. However, thrombectomy procedure time was not predictive of outcome on multivariable logistic regression analysis. Our study emphasizes the significance of achieving revascularization despite the requisite procedure time.

Download Full-text

Clinical Factors Associated with the Diagnosis of Granulomatosis with Polyangiitis

Otolaryngology ◽

10.1177/0194599816685696 ◽

2017 ◽

Vol 156 (3) ◽

pp. 484-488 ◽

Cited By ~ 4

Author(s):

Erdem Eren ◽

Toygar Kalkan ◽

Seçil Arslanoğlu ◽

Mustafa Özmen ◽

Kazım Önal ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Nasal Mucosa ◽

Odds Ratio ◽

Granulomatosis With Polyangiitis ◽

Univariate Analysis ◽

Binary Logistic Regression ◽

Binary Logistic Regression Analysis ◽

Significant Difference ◽

History Of

Objective To determine the predictive value of nasal endoscopic findings and symptoms in the diagnosis of granulomatosis with polyangiitis (GPA). Study Design A cross-sectional study. Setting A tertiary university hospital. Subjects and Methods A total of 116 adults were enrolled in the study: 19 patients with GPA, 29 patients with other rheumatic diseases, and 68 healthy volunteers. All patients were examined with a flexible endoscope, and nasal endoscopic images were recorded and evaluated blindly. The medical history of each patient was taken by a physician blinded to the patient’s diagnosis. Results Univariate analysis indicated a statistically significant difference in rhinorrhea ( P = .002), postnasal drip ( P = .015), epistaxis ( P < .001), and saddle nose ( P = .017). However, binary logistic regression analysis demonstrated that only history of epistaxis ( P = .012; odds ratio, 5.6) was statistically significant in predicting GPA. Univariate analysis showed a statistically significant difference in nasal secretion ( P = .028), nasal septal perforation ( P < .017), nasal crusting ( P < .001), nasal adhesion ( P < .001), nasal granuloma ( P = .017), and hemorrhagic fragile nasal mucosa ( P < .001). A binary logistic regression analysis demonstrated that only hemorrhagic fragile nasal mucosa ( P < .001; odds ratio, 52.9) was a statistically significant predictor of GPA. Conclusions Given the results of this study, we believe that hemorrhagic fragile nasal mucosa and history of recurrent epistaxis may put patients at risk for GPA and should be investigated accordingly.

Download Full-text

Anesthetic Agents and Cardiovascular Outcomes of Noncardiac Surgery after Coronary Stent Insertion

Journal of Clinical Medicine ◽

10.3390/jcm9020429 ◽

2020 ◽

Vol 9 (2) ◽

pp. 429

Author(s):

Hyun-Kyu Yoon ◽

Kwanghoon Jun ◽

Sun-Kyung Park ◽

Sang-Hwan Ji ◽

Young-Eun Jang ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Volatile Anesthetics ◽

Noncardiac Surgery ◽

Coronary Stent ◽

Multivariable Logistic Regression Analysis ◽

Volatile Agent ◽

Anesthetic Agents ◽

Coronary Stent Implantation ◽

Significant Difference

Patients undergoing noncardiac surgery after coronary stent implantation are at an increased risk of thrombotic complications. Volatile anesthetics are reported to have organ-protective effects against ischemic injury. Propofol has an anti-inflammatory action that can mitigate ischemia-reperfusion injury. However, the association between anesthetic agents and the risk of major adverse cardiovascular and cerebral event (MACCE) has never been studied before. In the present study, a total of 1630 cases were reviewed. Four different propensity score matchings were performed to minimize selection bias (propofol-based total intravenous anesthesia (TIVA) vs. volatile anesthetics; TIVA vs. sevoflurane; TIVA vs. desflurane; and sevoflurane vs. desflurane). The incidence of MACCE in these four propensity score-matched cohorts was compared. As a sensitivity analysis, a multivariable logistic regression analysis was performed to identify independent predictors for MACCE during the postoperative 30 days both in total and matched cohorts (TIVA vs. volatile agent). MACCE occurred in 6.0% of the patients. Before matching, there was a significant difference in the incidence of MACCE between TIVA and sevoflurane groups (TIVA 5.1% vs. sevoflurane 8.2%, p = 0.006). After matching, there was no significant difference in the incidence of MACCE between the groups of any pairs (TIVA 6.5% vs. sevoflurane 7.7%; p = 0.507). The multivariable logistic regression analysis revealed no significant association of the volatile agent with MACCE (odds ratio 1.48, 95% confidence interval 0.92–2.37, p = 0.104). In conclusion, the choice of anesthetic agent for noncardiac surgery did not significantly affect the development of MACCE in patients with previous coronary stent implantation. However, further randomized trials are needed to confirm our results.

Download Full-text

Newly Modified Descemetopexy Method in Descemet’s Membrane Detachment and Prognostic Analysis: A Systematic Review

10.21203/rs.3.rs-54725/v1 ◽

2020 ◽

Author(s):

Zhan Shen ◽

Rongmei Peng ◽

Gege Xiao ◽

Jing Hong

Keyword(s):

Logistic Regression ◽

Multiple Logistic Regression Analysis ◽

Univariate Analysis ◽

Dominant Factor ◽

Prognostic Analysis ◽

Descemet’S Membrane Detachment ◽

Significant Difference ◽

Descemet's Membrane ◽

Descemet’S Membrane ◽

Donor Characteristics

Abstract BackgroundTo present a newly modified descemetopexy method and investigate the most determinative factor in the prognosis of Descemet’s membrane detachment (DMD). MethodsThis was a retrospective review of 37 patients (38 eyes) treated with the newly modified descemetopexy method. This surgical method was combined with the vacuum technique to pump supra-Descemet’s fluid. After reviewing and screening, we enrolled 31 patients (32eyes). We evaluated outcomes using the anatomical reattachment of DM [anatomical success (AS)] and the resolution of corneal oedema [functional success (FS)]. Donor characteristics, including sex, age, the presence of diabetes, ocular history, DMD duration, DMD grade, were analysed. Patients were divided into two groups according to whether FS was achieved. Univariate and multi-factor logistic regression analyses were adopted to evaluate factors contributing to the prognosis of DMD. ResultsAS was achieved in 31 eyes (96.9%), and FS was achieved in 21 eyes (65.6%). The univariate analysis showed that both the DMD grade (P=0.029) and DMD duration (P=0.004) affect the prognosis of DMD. The multiple logistic regression analysis indicated that the DMD duration was the dominant factor (P=0.006). No significant difference was found in the DMD grade, sex, age, presence of diabetes, presence of glaucoma or DMD-originating surgery between the two groups.ConclusionsDescemetopexy combined with the vacuum technique can be used to deal with DMD. The DMD duration is the dominant factor affecting the activity of endothelial cells and the final prognosis.

Download Full-text

A multi-institution analysis of molecular biomarkers in patients with metastatic colorectal cancer in ethnically diverse populations.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e16074 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e16074-e16074

Author(s):

Zunaira H Choudhary ◽

Shailesh M Advani ◽

Nadia Ashai ◽

Sara Tariq ◽

Axel Grothey ◽

...

Keyword(s):

Clinical Outcomes ◽

Ethnic Groups ◽

Medical Center ◽

Univariate Analysis ◽

Ethnically Diverse ◽

Cancer Center ◽

Limited Information ◽

Nras Mutation ◽

Significant Difference ◽

Racial Ethnic

e16074 Background: Differences in clinical outcomes for metastatic CRC (mCRC) have been reported across racial-ethnic groups, particularly between Hispanics (HA), non-Hispanic Blacks (NHB), and non-Hispanic Whites (NHW), with limited information available among Asian Americans (AA). We examined if there were differences in clinical outcomes by molecular drivers between these groups in a pooled analysis of two institutions serving ethnically diverse patient populations. Methods: We retrospectively examined 1927 mCRC patients from Montefiore Medical Center and the University of Texas MD Anderson Cancer Center. Mutations in KRAS, NRAS, and BRAF were determined by polymerase chain reaction or next generation sequencing. Mutations were then correlated with overall survival (OS). Results: Our patient population consisted of 1153 (61%) NHW, 314 (17%) HA, 320 (17%) NHB and 59 (3.1%) AA. Across subgroups, borderline significant difference in prevalence of BRAF mutation was observed (p = 0.04), with higher prevalence observed among NHW as compared to other groups. No differences were observed for KRAS and NRAS mutation prevalence. In univariate analysis, the median survival for BRAF MT tumors was 18.5 months vs 32 months for BRAF WT tumors (p < 0.0001). Similarly, median OS for KRAS WT, KRAS MT, NRAS WT and NRAS MT was 29.3, 27.4, 31 and 31.5 months respectively, with no differences between groups. In subgroup analysis by race/ethnicity, median OS in BRAF MT NHW was 19.98 months vs 33.48 in BRAF WT NHW (p < 0.0001). Similar trends were observed in HA and NHB. No differences in median OS were observed by KRAS or NRAS mutation status across racial-ethnic groups. Conclusions: This multi-institution study found no meaningful difference in the prevalence of molecular drivers across racial-ethnic groups. Additionally, in our subgroup analyses, OS based on the presence of a specific molecular driver mutation did not seem to vary by race. For example, RAS mutated and BRAF mutated patients showed similar OS across racial-ethnic groups. Our study demonstrates that reported differences in clinical outcomes by race and ethnicity in the literature are unlikely to be dependent on the difference in the presence of certain molecular drivers.

Download Full-text

Risk Factors and Outcome of Children with Relapsed/Refractory Acute Leukemia after T-Cell-Rich Haploidentical Hematopoietic Cell Transplantation

Blood ◽

10.1182/blood.v128.22.4604.4604 ◽

2016 ◽

Vol 128 (22) ◽

pp. 4604-4604

Author(s):

Atsushi Kikuta ◽

Hideki Sano ◽

Kazuhiro Mochizuki ◽

Shogo Kobayashi ◽

Mitsuko Akaihata ◽

...

Keyword(s):

T Cell ◽

Acute Leukemia ◽

Acute Gvhd ◽

Conflicts Of Interest ◽

Chronic Gvhd ◽

Univariate Analysis ◽

Disease Free Survival ◽

T Cell Therapy ◽

Gvhd Prophylaxis ◽

Significant Difference

Abstract Background: T-cell rich (TCR) HLA-haploidentical SCT (haplo-SCT) is a form of T-cell therapy that has a high degree of efficacy in hematologic malignancies. Previously we reported the safety profile assessing GVHD prophylaxis that was conducted with anti-human thymocyte immunoglobulin (ATG), tacrolimus, methotrexate (MTX) and prednisolone (PSL) in unmanipulated haplo-SCT (Clin Transplant 2010, Transfus Med 2014). We evaluated efficacy and toxicity of TCR haplo-SCT in children with very high risk refractory/relapsed acute leukemia (VHR-R/R AL). Methods: VHR-R/R AL were defined as: relapse after SCT, very early or early relapse, induction failure(2 or more) and relapse of risk factor with MLL rearrangement, Ph+, Mo7 and 5q-. From Aug 2000 to April 2014, consecutive 38 patients (pts) with VHR-R/R AL who underwent TCR-haplo-SCT were included. The median age of pts was 8.2(0.3-19.1) years old. The diagnosis included ALL (n=27), AML (n=8), M/NKL (n=3). The disease status at TCR-haplo-SCT were 18 in CR (positive MRD: 8 pts), 20 in non-CR. HLA disparities were 2/8 in 1pt, 3/8 in 9 pts, 4/8 in 28 pts. Donors included fathers (n=21), mothers (n=14), and siblings (n=3). Thirty one pts received myeloablative conditioning (TBI based: 20 pts, Bu based: 11 pts) and 34 pts of them received ATG (rabbit, thymoglobulin 2.5mg/kg) containing regimen. The GVHD prophylaxis was conducted with tacrolimus, MTX and PSL. Thirty four pts received peripheral blood stem cells and 4 pts received BM. Results: Neutrophil engraftment (defined as >0.5x109/L) was 95% with a median day of 13 (range, 10-15). With a median 1640 days follow-up (range, 320-5510 days) in pts without events, the actuarial 3-year overall survival (OS) and disease-free survival (DFS) were 57% and 39%, respectively. On competing-risk analysis, 1-year cumulative incidences of grade II-IV acute GVHD and chronic GVHD were 71% and 63%, respectively; 3-year cumulative incidences of relapse and non-relapse mortality (NRM) were 40% and 20%. On univariate analysis, 3-year OS in pts with acute GVHD vs. without acute GVHD were 70% vs. 22% (p=.0006), in pts CR vs. non-CR at TCR-SCT were 83% vs. 32% (p=.007), in pts infused CD3 cell doses >=5 x 108/kg vs. <5 x 108/kg were 83% vs. 25% (p=.005), according to age at TCR-SCT <9 vs. >=9 were 79% vs. 34% (.008), respectively. In contrast, the occurrence of acute GVHD had no significant difference in infused CD3 cell doses. Conclusions: These data suggest that TCR haplo-SCT following low-dose ATG containing conditioning combined with our GVHD prophylaxis is well tolerated, facilitates engraftment, and has significant anti-leukemic activity, particularly in pediatric patients with refractory/ relapsed population. Disclosures No relevant conflicts of interest to declare.

Download Full-text

Predictors of outcome in civilian gunshot wounds to the head

Journal of Neurosurgery ◽

10.3171/2014.1.jns131869 ◽

2014 ◽

Vol 120 (5) ◽

pp. 1138-1146 ◽

Cited By ~ 44

Author(s):

Bizhan Aarabi ◽

Babak Tofighi ◽

Joseph A. Kufera ◽

Jeffrey Hadley ◽

Edward S. Ahn ◽

...

Keyword(s):

Logistic Regression ◽

Acute Care ◽

Injury Severity ◽

Univariate Analysis ◽

Gunshot Wounds ◽

Pupillary Response ◽

Favorable Outcome ◽

Multivariable Logistic Regression Analysis ◽

Gcs Score ◽

Basal Cisterns

Object Civilian gunshot wounds to the head (GSWH) are often deadly, but some patients with open cranial wounds need medical and surgical management and are potentially good candidates for acceptable functional recovery. The authors analyzed predictors of favorable clinical outcome (Glasgow Outcome Scale scores of 4 and 5) after GSWH over a 24-month period. Methods The authors posited 2 questions: First, what percentage of civilians with GSWH died in the state of Maryland in a given period of time? Second, what were the predictors of favorable outcome after GSWH? The authors examined demographic, clinical, imaging, and acute care data for 786 civilians who sustained GSWH. Univariate and logistic regression analyses were used to analyze the data. Results Of the 786 patients in this series, 712 (91%) died and 74 (9%) completed acute care in 9 trauma centers. Of the 69 patients admitted to one Maryland center, 46 (67%) eventually died. In 48 patients who were resuscitated, the Injury Severity Score was 26.2, Glasgow Coma Scale (GCS) score was 7.8, and an abnormal pupillary response (APR) to light was present in 41% of patients. Computed tomography indicated midline shift in 17%, obliteration of basal cisterns in 41.3%, intracranial hematomas in 34.8%, and intraventricular hemorrhage in 49% of cases. When analyzed for trajectory, 57.5% of bullet slugs crossed midcoronal, midsagittal, or both planes. Two subsets of admissions were studied: 27 patients (65%) who had poor outcome (25 patients who died and 2 who had severe disability) and 15 patients (35%) who had a favorable outcome when followed for a mean period of 40.6 months. Six patients were lost to follow-up. Univariate analysis indicated that admission GCS score (p < 0.001), missile trajectory (p < 0.001), surgery (p < 0.001), APR to light (p = 0.002), patency of basal cisterns (p = 0.01), age (p = 0.01), and intraventricular bleed (p = 0.03) had a significant relationship to outcome. Multivariable logistic regression analysis indicated that GCS score and patency of the basal cistern were significant determinants of outcome. Exclusion of GCS score from the regression models indicated missile trajectory and APR to light were significant in determining outcome. Conclusions Admission GCS score, trajectory of the missile track, APR to light, and patency of basal cisterns were significant determinants of outcome in civilian GSWH.

Download Full-text