Predictors of hospital prenotification for STEMI and association of prenotification with outcomes

BackgroundDelay to reperfusion in ST-elevation myocardial infarction (STEMI) is detrimental, but can be minimised with prehospital notification by ambulance to the treating hospital. We aimed to assess whether prenotification was associated with improved first medical contact to balloon times (FMC-BT) and whether this resulted in better clinical outcomes. We also aimed to identify factors associated with use of prenotification.MethodsThis was a retrospective study of prospective Victorian Cardiac Outcomes Registry data for patients undergoing primary percutaneous coronary intervention for STEMI from 2013-2018. Postcardiac arrest were excluded. Patients were grouped by whether they arrived by ambulance with prenotification (group 1), arrived by ambulance without prenotification (group 2) or self-presented (group 3). We compared groups by FMC-BT, incidence of major adverse cardiac and cerebrovascular events (MACCE), mortality and factors associated with the use of prenotification.Results2891 patients were in group 1 (79.3% male), 1620 in group 2 (75.7% male) and 1220 in group 3 (82.9% male). Patients who had prenotification were more likely to present in-hours (p=0.004) and self-presenters had lowest rates of cardiogenic shock (p<0.001). Prenotification had shorter FMC-BT than without prenotification (104 min vs 132 min, p<0.001) Self-presenters had superior clinical outcomes, with no difference between ambulance groups. Groups 1 and 2 had similar 30-day MACCE outcomes (7.4% group 1 vs 9.1% group 2, p=0.05) and similar mortality (4.6% group 1 vs 5.9% group 2, p=0.07). In multivariable analysis, male gender, right coronary artery culprit and in-hours presentation independently predicted use of prenotification (all p<0.05).ConclusionDifferences in clinical characteristics, particularly gender, time of presentation and culprit vessel may influence ambulance prenotification. Ambulance cohorts have high-risk features and worse outcomes compared with self-presenters. Improving system inequality in prehospital STEMI diagnosis is recommended for fastest STEMI treatment.

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Etiology of Cartilage Lesions Does Not Affect Clinical Outcomes of Patellofemoral Autologous Chondrocyte Implantation

Cartilage ◽

10.1177/19476035211030991 ◽

2021 ◽

pp. 194760352110309

Author(s):

Alexandre Barbieri Mestriner ◽

Jakob Ackermann ◽

Gergo Merkely ◽

Pedro Henrique Schmidt Alves Ferreira Galvão ◽

Luiz Felipe Morlin Ambra ◽

...

Keyword(s):

Clinical Outcomes ◽

Autologous Chondrocyte Implantation ◽

Second Generation ◽

Cartilage Lesion ◽

Chondrocyte Implantation ◽

Group 3 ◽

Group 2 ◽

Autologous Chondrocyte ◽

Group 1

Objective To determine the relationship between cartilage lesion etiology and clinical outcomes after second-generation autologous chondrocyte implantation (ACI) in the patellofemoral joint (PFJ) with a minimum of 2 years’ follow-up. Methods A retrospective review of all patients that underwent ACI in the PFJ by a single surgeon was performed. Seventy-two patients with a mean follow-up of 4.2 ± 2.0 years were enrolled in this study and were stratified into 3 groups based on the etiology of PFJ cartilage lesions: patellar dislocation (group 1; n = 23); nontraumatic lesions, including chondromalacia, osteochondritis dissecans, and degenerative defects (group 2; n = 28); and other posttraumatic lesions besides patellar dislocations (group 3; n = 21). Patient’s mean age was 29.6 ± 8.7 years. Patients in group 1 were significantly younger (25.4 ± 7.9 years) than group 2 (31.7 ± 9.6 years; P = 0.025) and group 3 (31.5 ± 6.6 years; P = 0.05). Body mass index averaged 26.2 ± 4.3 kg/m2, with a significant difference between group 1 (24.4 ± 3.2 kg/m2) and group 3 (28.7 ± 4.5 kg/m2; P = 0.005). A clinical comparison was established between groups based on patient-reported outcome measures (PROMs) and failure rates. Results Neither pre- nor postoperative PROMs differed between groups ( P > 0.05). No difference was seen in survivorship between groups (95.7% vs. 82.2% vs. 90.5%, P > 0.05). Conclusion Cartilage lesion etiology did not influence clinical outcome in this retrospective study after second generation ACI in the PFJ. Level of Evidence Level III, retrospective comparative study.

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Abstract WP380: Thyrotoxicosis is Associated With Worse In-Hospital Mortality in Patients With Ischemic Stroke

Stroke ◽

10.1161/str.51.suppl_1.wp380 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Sakiru O Isa ◽

Olajide Buhari ◽

Hameem Changezi

Keyword(s):

Ischemic Stroke ◽

Hospital Mortality ◽

Length Of Hospital Stay ◽

The Body ◽

Significant Difference ◽

History Of ◽

Group 3 ◽

Group 2 ◽

Time Of Presentation ◽

Group 1

Introduction: Hyperthyroidism increases the basal metabolic rate and affects most systems in the body. Patients with hyperthyroidism have been shown to have a higher incidence of ischemic stroke. There is a paucity of information regarding its effects on the short-term outcomes of patients admitted with ischemic stroke. Hypothesis: Hyperthyroidism is associated with worse in-hospital outcomes in patients admitted for ischemic stroke. Methods: We queried the National Inpatient Sample to identify adult patients(aged 18 and above) admitted for ischemic stroke between January 2011 and December 2014. We compared those with a history of hyperthyroidism (group 1) and thyrotoxicosis on admission (group 2) with the rest of the patients (group 3). The main outcome was in-hospital mortality. Secondary outcomes included the length of hospital stay and cost of hospitalization. We used the logistic regression model and adjusted for baseline characteristics and co-morbidities. Results: There were 643,786 patients in the study, 0.44% had a history of hyperthyroidism, and 0.01% had thyrotoxicosis at the time of presentation. The odd of mortality in group 1 compared to group 3 was 0.89, 95% CI 0.75-1.05, p=0.16 while in group 2 compared to group 3, it was 2.42, 95% CI 1.29-4.52, p<0.006. The mean length of stay was also longer in group 2 with a mean difference of 8.06, 95% CI 4.74 - 11.39, p<0.0001. Conclusion: From the study, there was no significant difference in in-hospital mortality between patients with previously diagnosed hyperthyroidism and those without diagnosed hyperthyroidism. Patients who had thyrotoxicosis on admission, on the other hand, had worse outcomes compared to patients without thyrotoxicosis.

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Necessary Factors to Achieve Deep Flexion for Asian Populations after Oxford Unicompartmental Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0039-1678539 ◽

2019 ◽

Vol 33 (03) ◽

pp. 294-300 ◽

Cited By ~ 2

Author(s):

Hiroshi Inui ◽

Shuji Taketomi ◽

Ryota Yamagami ◽

Kohei Kawaguchi ◽

Keiu Nakazato ◽

...

Keyword(s):

Clinical Outcomes ◽

Knee Arthroplasty ◽

Flexion Angle ◽

Maximum Flexion ◽

Asian Populations ◽

Maximum Flexion Angle ◽

Group 3 ◽

Group 2 ◽

Oxford Unicompartmental Knee Arthroplasty ◽

Group 1

AbstractThere have been many reports on the clinical outcomes of Oxford unicompartmental knee arthroplasty (UKA); however, none have investigated the influence of flexion angle after UKA on clinical outcomes. The objective of this study was to clarify the relationship between outcomes and the postoperative maximum flexion angle and reveal the necessary factors for maximum flexion angle ≥ 140 degrees which is considered necessary for Asian populations. We categorized 212 UKA patients into the following three groups based on the postoperative maximum flexion angle: group 1 had flexion angle ≥ 140 degrees in 80 patients (38%), group 2 had 130 degrees ≤ flexion angle < 140 degrees in 80 patients (38%), and group 3 had flexion angle < 130 degrees in 52 patients (24%). Furthermore, we compared the postoperative clinical outcomes between the three groups and conducted multivariable regression analyses to assess parameters affecting the flexion angle. Postoperative Knee Society function scores for group 1 was significantly higher than for group 3. Group 1 had higher mean knee injury and osteoarthritis outcome scores (KOOS) in all subscales and significantly higher KOOS scores in the sports and quality of life subscales compared with group 2 and in all subscales compared with group 3. Multivariable logistic regression showed that preoperative flexion angle and tibial component posterior slope were associated with maximum flexion angle ≥ 140 degrees. Maximum flexion angle ≥ 140 degrees after Oxford UKA improved the clinical results, particularly for patient-reported outcomes. Furthermore, the tibial posterior slope was an important factor in achieving maximum flexion angle ≥ 140 degrees in UKA patients.

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Novel Value of Preoperative Gamma-Glutamyltransferase Levels in the Prognosis of AFP-Negative Hepatocellular Carcinoma

Disease Markers ◽

10.1155/2020/4269460 ◽

2020 ◽

Vol 2020 ◽

pp. 1-11

Author(s):

Liang-He Lu ◽

Wei-Wei ◽

Anna Kan ◽

Jie-Mei ◽

Yi-Hong Ling ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Multivariable Analysis ◽

Tumor Development ◽

Disease Free Survival ◽

Tumor Burden ◽

Optimal Cutoff ◽

Gamma Glutamyltransferase ◽

Group 3 ◽

Group 2 ◽

Group 1

Background. Gamma-glutamyltransferase (GGT) is involved in tumor development and progression, but its prognostic value in α-fetoprotein- (AFP-) negative (AFP<25 ng/mL) hepatocellular carcinoma (HCC) patients remains unknown. Methods. A large cohort of 678 patients with AFP-negative HCC following curative resection who had complete data were enrolled in this study. The optimal cutoff value for the preoperative level of GGT was determined by the X-tile program. Independent prognostic factors for overall survival (OS) and disease-free survival (DFS) were also identified. Results. The optimal cutoff values for the preoperative levels of GGT were 37.2 U/L and 102.8 U/L, which were used to divide all patients into three subgroups (group 1, GGT<37.2 U/L (n=211, 31.1%); group 2, GGT≥37.2 and <102.8 U/L (n=320, 47.2%); group 3, GGT≥102.8 U/L (n=147, 21.7%)), with distinct OS times (58.5 vs. 53.5 vs. 44.4 months, P<0.001) and DFS times (47.9 vs. 40.3 vs. 30.1 months, P<0.001). Elevated preoperative GGT levels were associated with an unfavorable tumor burden (larger tumor size, multiple tumors, and microvascular invasion) and were selected as independent predictors of a worse OS (group 2 vs. group 1, HR: 1.73 (1.13-2.65), P=0.011; group 3 vs. group 1, HR: 3.28 (2.10-5.13), P<0.001) and DFS (group 2 vs. group 1, HR: 1.52 (1.13-2.05), P=0.006; group 3 vs. group 1, HR: 2.11 (1.49-2.98), P<0.001) in multivariable analysis. Conclusions. Elevated preoperative GGT levels are associated with an unfavorable tumor burden and serve as an independent prognostic marker for worse outcomes in AFP-negative HCC patients following resection.

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Abstract 2627: Outcomes After Endovascular Treatment For Anterior Circulation Stroke Presenting Beyond 8 Hours Of Time Last Seen Well Do Not Differ In Wake-up Strokes Vs. Witnessed Onset Beyond 8 Hours

Stroke ◽

10.1161/str.43.suppl_1.a2627 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Amin Aghaebrahim ◽

Carlos Leiva-Salinas ◽

Syed Zaidi ◽

Mouhammad Jumaa ◽

Xabi Urra ◽

...

Keyword(s):

Endovascular Treatment ◽

Clinical Outcomes ◽

Favorable Outcome ◽

Late Time ◽

Lesion Volume ◽

Anterior Circulation ◽

Tandem Occlusion ◽

Group 3 ◽

Group 2 ◽

Group 1

Objective: Patients with wake-up stroke are thought to have different outcomes compared to patients with known late time of onset. We thought to verify this hypothesis by determining clinical outcomes, mortality and rate of parenchymal hematoma (PH) in patients with anterior circulation large vessel occlusion stroke (ACLVOS) treated with endovascular therapy at our center. Methods: Retrospective review of a prospectively acquired database from consecutive patients meeting the following criteria: (1) ACLVOS, (2) endovascular treatment initiated beyond 8hrs from time last seen well (TLSW). Treatment selection was based on the presence of a small infarct core/large penumbra assessed through visual inspection on MRI or CTP by the treating physician. In patients undergoing MRI (n=55) pre-procedure infarct volumes on DWI were measured through automated volumetric analysis. Results: We identified 130 patients (mean age 64; mean baseline NIHSS 14, male gender 55%). Patients were divided into three groups. Group 1: patients with wake-up stroke (39%, n=51). Group 2: patients with witnessed onset beyond 8hrs from TLSW (55%, n=72). Group 3: patients without witnessed onset but TLSW>8hrs (5%, n=7). Occlusion locations were as follows: M1-55%, M2-12%, ICA terminus-32% and ICA origin (tandem occlusion)-28%. Successful recanalization (TIMI 2/3) was achieved in 109 patients (84%). The rate of 90 day favorable outcome (modified Rankin score (mRS) ≤ 2) was 55% (n=68/124). PH occurred in 15/130 (12%) patients and the 3 month mortality rate was 18% (n= 22/124). Favorable outcome rates amongst Group 1 (50%, n=24/48), Group 2 (59.5%, n=41/69) and Group 3 (42.9%, n=3/7) were not significantly different (p=0.49, by ANOVA). Mean pre-procedure DWI lesion volume was 18.7 cc in Group 1 vs. 18.3 cc in group 2 (p=0.9). No difference was noted between Group 1, Group 2 and Group3 regarding PH (13.7%, 8.3%, 13.3% respectively, p nonsignificant) or mortality at 3 months (18.7%, 17.4%, 14.3% respectively, p nonsignificant). Multivariate logistic regression model identified only successful recanalization (OR 2.9, p 0.001, CI 1.59-5.44) and age (OR 0.96, p 0.03, CI 0.93-0.99) as predictors of favorable outcome. Conclusion: In patients with ACLVOS presenting beyond 8 hours from TLSW who are selected based on similar imaging characteristics, clinical outcomes following endovascular treatment do not seem to differ according to mode of presentation relative to TLSW.

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Impact of Renal Function on Long-Term Clinical Outcomes in Patients With Coronary Chronic Total Occlusions: Results From an Observational Single-Center Cohort Study During the Last 12 Years

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2020.550428 ◽

2020 ◽

Vol 7 ◽

Author(s):

Lei Guo ◽

Huaiyu Ding ◽

Haichen Lv ◽

Xiaoyan Zhang ◽

Lei Zhong ◽

...

Keyword(s):

Renal Function ◽

Renal Insufficiency ◽

Clinical Outcomes ◽

Group 4 ◽

Significant Difference ◽

Group 3 ◽

Group 2 ◽

The Impact ◽

Group 1

Background: The number of coronary chronic total occlusion (CTO) patients with renal insufficiency is huge, and limited data are available on the impact of renal insufficiency on long-term clinical outcomes in CTO patients. We aimed to investigate clinical outcomes of CTO percutaneous coronary intervention (PCI) vs. medical therapy (MT) in CTO patients according to baseline renal function.Methods: In the study population of 2,497, 1,220 patients underwent CTO PCI and 1,277 patients received MT. Patients were divided into four groups based on renal function: group 1 [estimated glomerular filtration rate (eGFR) ≥ 90 ml/min/1.73 m2], group 2 (60 ≤ eGFR <90 ml/min/1.73 m2), group 3 (30 ≤ eGFR <60 ml/min/1.73 m2), and group 4 (eGFR <30 ml/min/1.73 m2). Major adverse cardiac event (MACE) was the primary end point.Results: Median follow-up was 2.6 years. With the decline in renal function, MACE (p < 0.001) and cardiac death (p < 0.001) were increased. In group 1 and group 2, MACE occurred less frequently in patients with CTO PCI, as compared to patients in the MT group (15.6% vs. 22.8%, p < 0.001; 15.6% vs. 26.5%, p < 0.001; respectively). However, there was no significant difference in terms of MACE between CTO PCI and MT in group 3 (21.1% vs. 28.7%, p = 0.211) and group 4 (28.6% vs. 50.0%, p = 0.289). MACE was significantly reduced for patients who received successful CTO PCI compared to patients with MT (16.7% vs. 22.8%, p = 0.006; 16.3% vs. 26.5%, p = 0.003, respectively) in group 1 and group 2. eGFR < 30 ml/min/1.73 m2, age, male gender, diabetes mellitus, heart failure, multivessel disease, and MT were identified as independent predictors for MACE in patients with CTOs.Conclusions: Renal impairment is associated with MACE in patients with CTOs. For treatment of CTO, compared with MT alone, CTO PCI may reduce the risk of MACE in patients without chronic kidney disease (CKD). However, reduced MACE from CTO PCI among patients with CKD was not observed. Similar beneficial effects were observed in patients without CKD who underwent successful CTO procedures.

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Risk factors for complications and graft failure in kidney transplant patients with sepsis

Bosnian Journal of Basic Medical Sciences ◽

10.17305/bjbms.2018.3874 ◽

2018 ◽

Author(s):

Syuan-Hao Syu ◽

Yung-Wei Lin ◽

Ke-Hsun Lin ◽

Liang-Ming Lee ◽

Chi-Hao Hsiao ◽

...

Keyword(s):

Kidney Transplant ◽

Graft Failure ◽

Peripheral Vascular ◽

Hepatitis C Infection ◽

Factors Associated ◽

Transplant Patients ◽

Kidney Transplant Patients ◽

Group 3 ◽

Group 2 ◽

Group 1

Immunosuppressive therapies decreased the incidence of acute kidney rejection after kidney transplantation, but also increased the risk of infections and sepsis. This study aimed to identify the risk factors associated with complications and/or graft failure in kidney transplant patients with sepsis. A total of 14,658 kidney transplant patients with sepsis, identified in the National Inpatient Sample (NIS) database (data from 2005–2014), were included in the study and classified into three groups: patients without complications or graft failure/dialysis (Group 1), patients with complications only (Group 2), and patients with complications and graft failure/dialysis (Group 3). Multinomial logistic regression analyses were conducted to evaluate factors associated with kidney transplant recipients. Multivariate analysis showed that, compared to Group 1, patients from Group 2 or Group 3 were more likely to be Black and to have cytomegalovirus infection, coagulopathy, and glomerulonephritis (p ≤ 0.041). Also, Group 2 was more likely to have herpes simplex virus infection, and Group 3 was more likely to have hepatitis C infection and peripheral vascular disorders, compared to Group 1 (p ≤ 0.002). In addition, patients from Group 3 were more likely to be Black and to have hepatitis C infection, peripheral vascular disorders, coagulopathy, and hypertension compared to Group 2 (p ≤ 0.039). Age and female gender were associated with lower odds of complications after kidney transplantation regardless of graft rejection/dialysis (p ≤ 0.049). Hyperlipidemia and diabetes decreased the chance of complications and graft failure/dialysis after kidney transplant (p < 0.001). In conclusion, the study highlights that black race, male gender, and specific comorbidities can increase the risk of complications and graft failure in kidney transplant patients with sepsis.

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Impacts of hemoglobin levels and platelet counts on clinical outcomes in patients with atrial fibrillation: oral anticoagulant use for patients with anemia and/or thrombocytopenia

European Heart Journal ◽

10.1093/eurheartj/ehab724.0554 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

T Chao ◽

Y.H Chan ◽

G.Y.H Lip ◽

S.A Chen

Keyword(s):

Atrial Fibrillation ◽

Clinical Outcomes ◽

Major Bleeding ◽

Oral Anticoagulant ◽

Oral Anticoagulants ◽

High Risk Population ◽

Group 3 ◽

Composite Risk ◽

Group 2 ◽

Group 1

Abstract Background Hemoglobin (Hgb) levels and platelet (PLT) counts have beeen associated with adverse clinical outcomes in some patients with cardiovascular conditions. We aimed to assess the risks of clinical events among patients with atrial fibrillation (AF) in relation to Hgb levels and PLT counts. Second, we investigated clinical outcomes on warfarin or non-vitamin K antagonist oral anticoagulants (NOACs) compared to no oral anticoagulant use (non-OAC), in different Hgb and PLT strata. Methods We used medical data from a multi-center healthcare system in Taiwan which included 37,074 AF patients. Patients were categorized into 3 groups based on their Hgb levels and PLT counts: Group 1 (Hgb>10g/dL and PLT>100K/uL; n=29,147), Group 2 (Hgb<10g/dL or PLT<100K/uL; n=7,078) and Group 3 (Hgb<10g/dL and PLT<100K/uL; n=849). Patients in each category were further stratified as 3 groups according to their stroke prevention strategies; that is, non-OAC, warfarin or NOACs. Results A higher Hgb level and/or PLT count was associated with a higher risk of ischemic stroke/systemic embolism (IS/SE), but lower risks of intracranial hemorrhage (ICH) and major bleeding. The composite risks of IS/SE, ICH and major bleeding were higher in Group 3 or Group 2, compared to Group 1 (6.75%/yr versus 6.41%/yr versus 4.13%/yr). Compared to non-OACs, the use of warfarin was not associated with a lower composite risk of IS/SE, ICH and major bleeding in the 3 groups. NOACs were associated with a lower composite risk in Group 1 (aHR 0.68, 95% CI 0.60–0.76) and Group 2 (aHR 0.73, 95% CI 0.53–0.99), but was non-significant in Group 3 (aHR 0.73, 95% CI 0.17–3.07) (Figure). The net clinical benefits were consistently positive in different weight models, in favor of NOAC use, in Group 2 and its subgroups with either anemia or thrombocytopenia. Conclusions AF patients with anemia and/or thrombocytopenia were a high-risk population. Compared to no OAC use, NOACs were associated with significantly better clinical outcomes for patients with advanced anemia (Hgb<10g/dL) or thrombocytopenia (PLT<100K/uL), but not for those with both conditions. Harms or benefits of NOACs should be carefully evaluated and balanced in this population. FUNDunding Acknowledgement Type of funding sources: None.

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Surgical outcomes for older patients with glioblastoma multiforme: preoperative factors associated with decreased survival

Journal of Neurosurgery ◽

10.3171/2010.8.jns1081 ◽

2011 ◽

Vol 114 (3) ◽

pp. 587-594 ◽

Cited By ~ 101

Author(s):

Kaisorn L. Chaichana ◽

Khan K. Chaichana ◽

Alessandro Olivi ◽

Jon D. Weingart ◽

Richard Bennett ◽

...

Keyword(s):

Glioblastoma Multiforme ◽

Median Survival ◽

Older Patients ◽

Motor Deficit ◽

Factors Associated ◽

Group 3 ◽

Group 2 ◽

Insight Into ◽

Preoperative Factors ◽

Group 1

Object As the population ages, the incidence of glioblastoma multiforme (GBM) among older patients (age > 65 years) will increase. Older patients, unlike their younger counterparts, are not often offered aggressive surgery because of their age, comorbidities, and potential inability to tolerate surgery. The goal of this study was to identify preoperative factors associated with decreased survival for older patients who underwent resection of a GBM. The identification of these factors may provide insight into which patients would benefit most from aggressive surgery. Methods All patients older than 65 years who underwent nonbiopsy resection of an intracranial GBM at a single institution between 1997 and 2007 were retrospectively reviewed. Factors associated with overall survival were assessed using multivariate proportional hazards regression analysis after controlling for peri- and postoperative factors known to be associated with outcome (extent of resection, carmustine wafer implantation, temozolomide chemotherapy, and radiation therapy). Variables with p < 0.05 were considered statistically significant. Results A total of 129 patients with an average age of 73 ± 5 years met the inclusion/exclusion criteria. At last follow-up, all 129 patients had died, with a median survival of 7.9 months. The preoperative factors that were independently associated with decreased survival were Karnofsky Performance Scale (KPS) score less than 80 (p = 0.001), chronic obstructive pulmonary disease (p = 0.01), motor deficit (p = 0.01), language deficit (p = 0.005), cognitive deficit (p = 0.02), and tumor size larger than 4 cm (p = 0.002). Patients with 0–1 (Group 1), 2–3 (Group 2), and 4–6 (Group 3) of these factors had statistically different survival times, where the median survival was 9.2, 5.5, and 4.4 months, respectively. In log-rank analysis, the median survival for Group 1 was significantly longer than that for Group 2 (p = 0.004) and Group 3 (p < 0.0001), while Group 2 had longer survival than Group 3 (p = 0.02). Conclusions Older patients with an increasing number of these factors may not benefit as much from aggressive surgery as patients with fewer factors. This may provide insight into identifying which patients older than 65 years of age may benefit from aggressive surgery.

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PO 8595 FACTORS ASSOCIATED WITH VIROLOGIC FAILURE AMONG WOMEN WITH PRIOR EXPOSURE TO ANTIRETROVIRAL DRUGS FOR PMTCT, KISUMU, KENYA

BMJ Global Health ◽

10.1136/bmjgh-2019-edc.159 ◽

2019 ◽

Vol 4 (Suppl 3) ◽

pp. A60.3-A61

Author(s):

Francis Angira ◽

Eucabeth Awuonda ◽

Jacinter Oruko ◽

Oyaro Boaz ◽

Elijah Asadhi ◽

...

Keyword(s):

Virologic Failure ◽

Antiretroviral Drugs ◽

Prior Exposure ◽

Hiv Care ◽

First Line ◽

Factors Associated ◽

Art Initiation ◽

Group 3 ◽

Group 2 ◽

Group 1

BackgroundUse of antiretroviral drugs (ARVs) for a discrete period for Preventing Mother-to-Child HIV transmission (PMTCT) only may be compared to Structured Treatment Interruption, which has been associated with virologic failure (VF). We sought to determine factors associated with VF among women on Antiretroviral Therapy (ART) but with prior exposure to short-term ARVs for PMTCT.MethodsHIV-infected women presenting for ART initiation in three HIV care clinics in Kisumu County, Kenya were enrolled in the KiBS follow-up study (2010–2013) if they had previously received triple ARVs for PMTCT (Group 1) or short-course ARVs for PMTCT (Group 2) or were ARVs-naïve (Group 3). First-line ART was provided as per 2010 WHO treatment guidelines and viral load (VL) tests were conducted every six months for 24 months. VF was defined as any confirmed VL value ≥400 copies/ml after 6 months of ART initiation. Frequencies and proportions were used in the descriptive analysis while Pearson’s Chi-square/Fisher’s exact test was used to determine the association between VF and eight independent variables. Univariate and Multivariate Cox-proportional regression model was fitted to investigate factors associated with VF.ResultsOut of 284 participants data for 245 were analysed (Group 1: 27; Group 2: 107; Group 3: 111). Majority were aged 25–29 years and over 60% had primary/lesser education. There were 39 (Group 1: 5; Group 2: 16; Group 3: 18) VFs with a total VF incidence of 8.12 [95% CI (5.96, 11.17)] per 1000 Person months of observation (PMOs). Group 2 had the lowest VF incidence. Baseline CD4 <349 cells/mm3 and initiation/use of TDF/3TC/EFV were associated with virologic failure (VF).ConclusionWomen at risk of VF based on the identified risk factors should be identified and targeted with appropriate intervention. Further studies are needed to verify and understand the mechanisms of association between VF and TDF/3TC/EFV which is a WHO-recommended first-line ART regimen.

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