Prognosis of Intracerebral Hemorrhage Related to Antithrombotic Use

Background and Purpose: To date, large studies comparing mortality and functional outcome of intracerebral hemorrhage (ICH) during oral anticoagulant (OAC), antiplatelet, and nonantithrombotic use are few and show discrepant results. Methods: We used data on 13 291 patients with ICH registered in Riksstroke between 2012 and 2016 to compare 90-day mortality and functional outcome following OAC-related ICH (n=2300), antiplatelet-related ICH (n=3637), and nonantithrombotic ICH (n=7354). Univariable and multivariable Cox regression analyses, with adjustment for relevant confounders, were used to compare 90-day mortality. Early (≤24 hours and 1–7 days) and late (8–90 days) mortality was also studied in subgroup analyses. Univariable and multivariable 90-day functional outcome, based on self-reported modified Rankin Scale, was determined using logistic regression. Results: Patients with antithrombotic treatment were more often prestroke dependent, older, and had a larger comorbidity burden compared with patients without antithrombotic treatment. At 90 days, antiplatelet and OAC were associated with an increased death rate in multivariable analysis (antiplatelet ICH: hazard ratio, 1.23 [95% CI, 1.14–1.33]; OAC ICH: hazard ratio, 1.40 [95% CI, 1.26–1.57]) compared with nonantithrombotic ICH (reference). OAC ICH and antiplatelet ICH were associated with higher risk of early mortality (≤24 hours: OAC ICH: hazard ratio, 1.93 [95% CI, 1.57–2.38]; antiplatelet ICH: hazard ratio, 1.32 [95% CI, 1.13–1.54]). In multivariable analysis, the odds ratios for the association of antiplatelet and OAC treatment on functional dependency (modified Rankin Scale score, 3–5) at 90 days were nonsignificant (antiplatelet: odds ratio, 1.07 [95% CI, 0.92–1.24]; OAC: odds ratio, 0.96 [95% CI, 0.76–1.22]). Conclusions: In this large observational study, we found that 90-day mortality outcome was worse not only in OAC ICH but also in antiplatelet ICH, compared with patients with nonantithrombotic ICH. Antiplatelet ICH is common and is a serious condition with poor clinical outcome. Further studies are, therefore, warranted in determining the appropriate clinical management of these patients.

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Patterns of Care and Survival of Cutaneous Angiosarcoma of the Head and Neck

Otolaryngology ◽

10.1177/0194599820905495 ◽

2020 ◽

Vol 162 (6) ◽

pp. 881-887 ◽

Cited By ~ 1

Author(s):

Clifford Chang ◽

S. Peter Wu ◽

Kenneth Hu ◽

Zujun Li ◽

David Schreiber ◽

...

Keyword(s):

Head And Neck ◽

Cox Regression ◽

Multivariable Analysis ◽

Multimodality Treatment ◽

The Elderly ◽

Hazard Ratio ◽

Patterns Of Care ◽

Definitive Treatment ◽

National Cancer Database ◽

Curative Intent

Objective To analyze the patterns of care and survival of cutaneous angiosarcomas of the head and neck. Study Design Retrospective cohort study. Setting National Cancer Database. Methods The National Cancer Database was queried to select patients with cutaneous angiosarcoma of the head and neck between 2004 and 2015. For survival analysis, patients were included only if they received definitive treatment and complete data. Prognostic factors were analyzed by univariate and multivariable Cox regression. Results We identified 693 patients diagnosed with head and neck angiosarcomas during the study period. The majority were male (n = 489, 70.6%) and elderly (median, 77 years). A total of 421 patients (60.8%) met the criteria for survival analyses. These patients were treated with surgery and radiation (n = 178, 42.3%), surgery alone (n = 138, 32.8%), triple-modality therapy (n = 48, 11.4%), surgery and chemotherapy (n = 29, 6.9%), and chemoradiation (n = 28, 6.7%). With a median follow-up of 29 months, the 3-year survival was 50.1%. Patients undergoing surgery had better median survival than those who did not (38.1 vs 21.0 months, P = .04). Age, comorbidity, tumor size, and surgical margins were significant factors in univariate analyses. On multivariable analysis, age ≥75 years (hazard ratio, 2.65; 95% CI, 1.80-3.88; P < .001) and positive margins (hazard ratio, 1.91; 95% CI, 1.44-2.51; P < .001) predicted worse overall survival. Conclusion Angiosarcoma of head and neck is a rare malignancy that affects the elderly. Surgical treatment with negative margins is associated with improved survival. Even with curative-intent multimodality treatment, the survival of patients aged ≥75 years is limited.

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Antiplatelet Therapy After Spontaneous Intracerebral Hemorrhage and Functional Outcomes

Stroke ◽

10.1161/strokeaha.119.025972 ◽

2019 ◽

Vol 50 (11) ◽

pp. 3057-3063

Author(s):

Santosh B. Murthy ◽

Alessandro Biffi ◽

Guido J. Falcone ◽

Lauren H. Sansing ◽

Victor Torres Lopez ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Antiplatelet Therapy ◽

Functional Outcomes ◽

Randomized Clinical Trials ◽

Massachusetts General Hospital ◽

Meta Analysis ◽

Hazard Ratio ◽

Stroke Registry ◽

All Cause Mortality

Background and Purpose— Observational data suggest that antiplatelet therapy after intracerebral hemorrhage (ICH) alleviates thromboembolic risk without increasing the risk of recurrent ICH. Given the paucity of data on the relationship between antiplatelet therapy after ICH and functional outcomes, we aimed to study this association in a multicenter cohort. Methods— We meta-analyzed data from (1) the Massachusetts General Hospital ICH registry (n=1854), (2) the Virtual International Stroke Trials Archive database (n=762), and (3) the Yale stroke registry (n=185). Our exposure was antiplatelet therapy after ICH, which was modeled as a time-varying covariate. Our primary outcomes were all-cause mortality and a composite of major disability or death (modified Rankin Scale score 4–6). We used Cox proportional regression analyses to estimate the hazard ratio of death or poor functional outcome as a function of antiplatelet therapy and random-effects meta-analysis to pool the estimated HRs across studies. Additional analyses stratified by hematoma location (lobar and deep ICH) were performed. Results— We included a total of 2801 ICH patients, of whom 288 (10.3%) were started on antiplatelet medications after ICH. Median times to antiplatelet therapy ranged from 7 to 39 days. Antiplatelet therapy after ICH was not associated with mortality (hazard ratio, 0.85; 95% CI, 0.66–1.09), or death or major disability (hazard ratio, 0.83; 95% CI, 0.59–1.16) compared with patients not started on antiplatelet therapy. Similar results were obtained in additional analyses stratified by hematoma location. Conclusions— Antiplatelet therapy after ICH appeared safe and was not associated with all-cause mortality or functional outcome, regardless of hematoma location. Randomized clinical trials are needed to determine the effects and harms of antiplatelet therapy after ICH.

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Acquired infection during neonatal and pediatric extracorporeal membrane oxygenation

Perfusion ◽

10.1177/0267659118766436 ◽

2018 ◽

Vol 33 (6) ◽

pp. 472-482 ◽

Cited By ~ 10

Author(s):

Katherine Cashen ◽

Ron Reeder ◽

Heidi J. Dalton ◽

Robert A. Berg ◽

Thomas P. Shanley ◽

...

Keyword(s):

Viral Infections ◽

Cox Regression ◽

Multivariable Analysis ◽

Secondary Analysis ◽

Hazard Ratio ◽

Research Network ◽

Factors Associated ◽

Increased Risk ◽

Neonatal Icu ◽

Pediatric Icu

Introduction: Our objectives are to (1) describe the pathogens, site, timing and risk factors for acquired infection during neonatal and pediatric ECMO and (2) explore the association between acquired infection and mortality. Methods: Secondary analysis of prospective data collected by the Collaborative Pediatric Critical Care Research Network between December 2012 and September 2014. Clinical factors associated with acquired infection were assessed with multivariable Cox regression. Factors associated with mortality were assessed with logistic regression. Results: Of 481 patients, 247 (51.3%) were neonates and 400 (83.2%) received venoarterial ECMO. Eighty (16.6%) patients acquired one or more infections during ECMO; 60 (12.5%) patients had bacterial, 21 (4.4%) had fungal and 11 (2.3%) had viral infections. The site of infection included respiratory for 53 (11.0%) patients, bloodstream for 21 (4.4%), urine for 20 (4.2%) and other for 7 (1.5%). Candida species were most common. Median time to infection was 5.2 days (IQR 2.3, 9.6). On multivariable analysis, a greater number of procedures for ECMO cannula placement was independently associated with increased risk of acquired infection during ECMO (Hazard Ratio 2.13 (95% CI 1.22, 3.72), p<0.01) and receiving ECMO in a neonatal ICU compared to a pediatric or cardiac ICU was associated with decreased risk (Hazard Ratio pediatric ICU 4.25 (95% CI 2.20, 8.20), cardiac ICU 2.91 (95% CI 1.48, 5.71), neonatal ICU as reference, p<0.001). Acquired infection was not independently associated with mortality. Conclusion: ECMO procedures and location may contribute to acquired infection risk; however, acquired infection did not predict mortality in this study.

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POST-NOAC: Portuguese observational study of intracranial hemorrhage on non-vitamin K antagonist oral anticoagulants

International Journal of Stroke ◽

10.1177/1747493016681021 ◽

2016 ◽

Vol 12 (6) ◽

pp. 623-627 ◽

Cited By ~ 11

Author(s):

Cláudia Marques-Matos ◽

José Nuno Alves ◽

João Pedro Marto ◽

Joana Afonso Ribeiro ◽

Ana Monteiro ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Intracranial Hemorrhage ◽

Vitamin K ◽

Vitamin K Antagonists ◽

Oral Anticoagulants ◽

Anticoagulation Therapy ◽

Vitamin K Antagonist ◽

Significant Shift ◽

Modified Rankin Scale

Background There is a lower reported incidence of intracranial hemorrhage with non-vitamin K antagonist oral anticoagulants compared with vitamin K antagonist. However, the functional outcome and mortality of intracranial hemorrhage patients were not assessed. Aims To compare the outcome of vitamin K antagonists- and non-vitamin K antagonist oral anticoagulants-related intracranial hemorrhage. Methods We included consecutive patients with acute non-traumatic intracranial hemorrhage on oral anticoagulation therapy admitted between January 2013 and June 2015 at four university hospitals. Clinical and demographic data were obtained from individual medical records. Intracranial hemorrhage was classified as intracerebral, extra-axial, or multifocal using brain computed tomography. Three-month functional outcome was assessed using the modified Rankin Scale. Results Among 246 patients included, 24 (9.8%) were anticoagulated with a non-vitamin K antagonist oral anticoagulants and 222 (90.2%) with a vitamin K antagonists. Non-vitamin K antagonist oral anticoagulants patients were older (81.5 vs. 76 years, p = 0.048) and had intracerebral hemorrhage more often (83.3% vs. 63.1%, p = 0.048). We detected a non-significant trend for larger intracerebral hemorrhage volumes in vitamin K antagonists patients ( p = 0.368). Survival analysis adjusted for age, CHA2DS2VASc, HAS-BLED, and anticoagulation reversal revealed that non-vitamin K antagonist oral anticoagulants did not influence three-month mortality (hazard ratio (HR) = 0.83, 95% confidence interval (CI) = 0.39–1.80, p = 0.638). Multivariable ordinal regression for three-month functional outcome did not show a significant shift of modified Rankin Scale scores in non-vitamin K antagonist oral anticoagulants patients (odds ratio (OR) 1.26, 95%CI 0.55–2.87, p = 0.585). Conclusions We detected no significant differences in the three-month outcome between non-vitamin K antagonist oral anticoagulants- and vitamin K antagonists-associated intracranial hemorrhage, despite unavailability of non-vitamin K antagonist oral anticoagulants-specific reversal agents.

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Association of Serum IL-6 (Interleukin 6) With Functional Outcome After Intracerebral Hemorrhage

Stroke ◽

10.1161/strokeaha.120.032888 ◽

2021 ◽

Author(s):

Audrey C. Leasure ◽

Lindsey R. Kuohn ◽

Kevin N. Vanent ◽

Matthew B. Bevers ◽

W. Taylor Kimberly ◽

...

Keyword(s):

Treatment Group ◽

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Interleukin 6 ◽

Factor Vii ◽

Modified Rankin Scale ◽

Predictors Of Outcome ◽

Edema Volume ◽

Secondary Analyses ◽

Perihematomal Edema

Background and Objectives: IL-6 (interleukin 6) is a proinflammatory cytokine and an established biomarker in acute brain injury. We sought to determine whether admission IL-6 levels are associated with severity and functional outcome after spontaneous intracerebral hemorrhage (ICH). Methods: We performed an exploratory analysis of the recombinant activated FAST trial (Factor VII for Acute ICH). Patients with admission serum IL-6 levels were included. Regression analyses were used to assess the associations between IL-6 and 90-day modified Rankin Scale. In secondary analyses, we used linear regression to evaluate the association between IL-6 and baseline ICH and perihematomal edema volumes. Results: Of 841 enrolled patients, we included 552 (66%) with available admission IL-6 levels (mean age 64 [SD 13], female sex 203 [37%]). IL-6 was associated with poor outcome (modified Rankin Scale, 4–6; per additional 1 ng/L, odds ratio, 1.30 [95% CI, 1.04–1.63]; P =0.02) after adjustment for known predictors of outcome after ICH and treatment group. IL-6 was associated with ICH volume after adjustment for age, sex, and ICH location, and this association was modified by location (multivariable interaction, P =0.002), with a stronger association seen in lobar (β, 12.51 [95% CI, 6.47–18.55], P <0.001) versus nonlobar (β 5.32 [95% CI, 3.36–7.28], P <0.001) location. IL-6 was associated with perihematomal edema volume after adjustment for age, sex, ICH volume, and ICH location (β 1.22 [95% CI, 0.15–2.29], P =0.03). Treatment group was not associated with IL-6 levels or outcome. Conclusions: In the FAST trial population, higher admission IL-6 levels were associated with worse 90-day functional outcome and larger ICH and perihematomal edema volumes.

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Factors associated with survival in patients with COVID -19 admitted to a community hospital in New York City

Journal of Lung Pulmonary & Respiratory Research ◽

10.15406/jlprr.2021.08.00247 ◽

2021 ◽

Vol 8 (2) ◽

pp. 27-33

Author(s):

Ajay P Singh ◽

Ahmed Shady ◽

Ejiro Gbaje ◽

Marlon Oliva ◽

Samantha Golden Espinal ◽

...

Keyword(s):

New York ◽

New York City ◽

Oxygen Saturation ◽

York City ◽

Odds Ratio ◽

Community Hospital ◽

Cox Regression ◽

The Elderly ◽

Hazard Ratio ◽

Study Population

Introduction: COVID-19 has been associated with increased mortality in old age, hypertension and male gender. Higher prevalence of increased body mass index (BMI), mechanical ventilation and renal failure has been found in the patients admitted to our New York City community hospital; accordingly we aim to explore the association between these parameters and survival in our patients. Methods: Retrospective review of patients admitted with the COVID-19 disease March 14 to April 30 of 2020. Analysis using Cox regression models, Log rank tests and Kaplan Meier curves was done for a total of 326 patients that met our criteria. Results: The adjusted odds of death for those at least 75 years of age were higher than those within the age group of 18 to 44 years. The patients with over 92% oxygen saturation had lower adjusted odds of death than those with 88 to 92% oxygen saturation (Odds Ratio (OR)=0.2, 95% CI=0.06, 0.70), as well as lower adjusted hazard of dying (Hazard Ratio (HR)=0.4, 95% CI=0.21, 0.87). Intubation was associated with a higher adjusted odds ratio (OR=57.8, 95% CI=17.74, 188.30) and adjusted hazard ratio HR=5.4 (95% CI=2.59, 11.21) for death. After controlling for age and gender, neither levels of serum D-dimer nor creatinine were found to be significantly associated with mortality The factors that comprise metabolic syndrome, i.e., elevated BMI, diabetes, hypertension, and hyperlipidemia, were found to have no significant association with the outcome of death after controlling for age and sex and they also had no significant association with the time until death. Conclusions: In the study population, COVID-19 was associated with increased mortality in patients who required intubation, and in the elderly, which may be explained by changes in the immune system over time. Elevated BMI, though not statistically significant, was present in the majority of our study population, which may have contributed to the group's high mortality.

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Temporal Trend of Comorbidity and Increasing Impacts on Mortality, Length of Stay, and Hospital Costs of First Stroke in Tianjin, North of China

10.21203/rs.3.rs-796597/v1 ◽

2021 ◽

Author(s):

Ruixiao Hao ◽

Xuemei Qi ◽

Xiaoshuang Xia ◽

Lin Wang ◽

Xin Li

Keyword(s):

Length Of Stay ◽

Hospital Mortality ◽

Cox Regression ◽

Hospital Costs ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

Kaplan Meier ◽

Comorbidity Burden ◽

Hospitalization Costs ◽

Severe Comorbidity

Abstract Purpose: Stroke patients have a high incidence of comorbidity. Our study aimed to explore the trend of comorbidity among patients with first stroke from 2010 to 2020, and the influence of comorbidity on admission mortality, length of stay and hospitalization costs.5988 eligible patients were enrolled in our study, and divided into 4 comorbidity burden groups according to Charlson comorbidity index (CCI): none, moderate, severe, very severe. Survival analysis was expressed by Kaplan - Meier curve. Cox regression model was used to analyze the effect of comorbidity on 7-day and in-hospital mortality. Generalized linear model (GLM) was used to analyze the association between comorbidity and hospitalization days and cost. Results: Compared to patients without comorbidity, those with very severe comorbidity were more likely to be male (342, 57.7%), suffer from ischemic stroke (565, 95.3%), afford higher expense (Midian, 19339.3RMB, IQR13020.7-27485.9RMB), and have a higher in-hospital mortality (60, 10.1%). From 2010 to 2020, proportion of patients with severe and very severe comorbidity increased 12.9%. The heaviest comorbidity burden increased the risk of 7-day mortality (adjusted hazard ratio, 3.51, 95% CI, 2.22-5.53) and in-hospital mortality (adjusted hazard ratio, 3.83, 95% CI, 2.70-5.45). Patients with very severe comorbidity had a 12% longer LOS and extra 27% expense than those without comorbidity.Conclusion: Comorbidity burden showed an increasing trend year in past eleven years. The heavy comorbidity burden increased in-hospital mortality, LOS, and hospitalization cost, especially in patients aged 55 years or more.

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MRI predicts intracranial hemorrhage in patients who receive long-term oral anticoagulation

Neurology ◽

10.1212/wnl.0000000000007532 ◽

2019 ◽

Vol 92 (21) ◽

pp. e2432-e2443 ◽

Cited By ~ 18

Author(s):

Joan Martí-Fàbregas ◽

Santiago Medrano-Martorell ◽

Elisa Merino ◽

Luis Prats-Sánchez ◽

Rebeca Marín ◽

...

Keyword(s):

Ischemic Stroke ◽

White Matter ◽

Intracranial Hemorrhage ◽

White Matter Hyperintensities ◽

Cox Regression ◽

Multivariable Analysis ◽

Hazard Ratio ◽

Superficial Siderosis ◽

Increased Risk

ObjectiveWe tested the hypothesis that the risk of intracranial hemorrhage (ICH) in patients with cardioembolic ischemic stroke who are treated with oral anticoagulants (OAs) can be predicted by evaluating surrogate markers of hemorrhagic-prone cerebral angiopathies using a baseline MRI.MethodsPatients were participants in a multicenter and prospective observational study. They were older than 64 years, had a recent cardioembolic ischemic stroke, and were new users of OAs. They underwent a baseline MRI analysis to evaluate microbleeds, white matter hyperintensities, and cortical superficial siderosis. We collected demographic variables, clinical characteristics, risk scores, and therapeutic data. The primary endpoint was ICH that occurred during follow-up. We performed bivariate and multivariate Cox regression analyses.ResultsWe recruited 937 patients (aged 77.6 ± 6.5 years; 47.9% were men). Microbleeds were detected in 207 patients (22.5%), moderate/severe white matter hyperintensities in 419 (45.1%), and superficial siderosis in 28 patients (3%). After a mean follow-up of 23.1 ± 6.8 months, 18 patients (1.9%) experienced an ICH. In multivariable analysis, microbleeds (hazard ratio 2.7, 95% confidence interval [CI] 1.1–7, p = 0.034) and moderate/severe white matter hyperintensities (hazard ratio 5.7, 95% CI 1.6–20, p = 0.006) were associated with ICH (C index 0.76, 95% CI 0.66–0.85). Rate of ICH was highest in patients with both microbleed and moderate/severe WMH (3.76 per 100 patient-years, 95% CI 1.62–7.4).ConclusionPatients taking OAs who have advanced cerebral small vessel disease, evidenced by microbleeds and moderate to severe white matter hyperintensities, had an increased risk of ICH. Our results should help to determine the risk of prescribing OA for a patient with cardioembolic stroke.ClinicalTrials.gov identifierNCT02238470.

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Predictors of surgical outcome among patients with spontaneous supratentorial intracerebral hemorrhage: A prospective single institutional study

Nepal Journal of Neuroscience ◽

10.3126/njn.v18i2.33963 ◽

2021 ◽

Vol 18 (2) ◽

pp. 23-29

Author(s):

Somraj Lamichhane ◽

Ruchi Devbhandari ◽

Sabin Tripathee ◽

Manisha Chapagain

Keyword(s):

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Decompressive Craniectomy ◽

Young Patients ◽

Functional Independence ◽

Modified Rankin Scale ◽

Dominant Hemisphere ◽

Co Morbidity ◽

Surgical Evacuation

Introduction: Intracerebral hemorrhage (ICH) is a potentially devastating neurologic emergency with long-term functional independence achieved in only limited patients with good prognostic factors. The objective of this study is toidentify the predictors of functional outcome in terms of modified Rankin Scale (mRS) following craniotomy and evacuation of spontaneous supratentorial ICH. Methodology: It is a prospective study of forty patients conducted at the College of Medical Sciences (CMS) from May 2019 to April 2020 with three months follow-up. Patients of spontaneous supratentorial ICH with features of raised ICP and deteriorating GCS underwent surgical evacuation. The various predictors of outcome like Glasgow Coma Score (GCS) and pupillary inequality at presentation, age, location of hematoma, clot volume, comorbidities, intra-ventricular extension and involvement of dominant hemisphere were documented and compared with outcome in terms of modified Rankin Scale (mRS). Results: The mortality rate at three months was 25% (32% in deep seated and 13.3% in lobar ICH) and higher in patients with poor GCS and pupillary inequality at presentation, volume >100 ml, intra-ventricular extension and patients undergoing decompressive craniectomy. Twenty patients (50%) had a favorable outcome (mRS 1-3) at follow-up, while 20 (50%) had a poor outcome (mRS 4-6). Unfavorable outcome was significantly higher among deep seated hematoma, age>70 years, poor GCS and pupillary inequality at presentation, clot volume >100ml, pre-existing co-morbidity, patients undergoing decompressive craniectomy and involvement of dominant hemisphere. Conclusion: Surgical evacuation of spontaneous supratentorial ICH is associated with high mortality in patients with poor GCS and pupillary inequality at presentation, and large clot volume with intraventricular extension. However, young patients with good pre-morbid status, moderate volume of hematoma, not involving dominant hemisphere and moderate to good GCS have good functional outcome.

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The Clinical Significance of Crohn Disease Activity at Resection Margins

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2018-0011-oa ◽

2018 ◽

Vol 143 (4) ◽

pp. 505-509 ◽

Cited By ~ 5

Author(s):

Sasan Setoodeh ◽

Li Liu ◽

Sarag A. Boukhar ◽

Amit G. Singal ◽

Maria Westerhoff ◽

...

Keyword(s):

Disease Activity ◽

Clinical Significance ◽

Crohn Disease ◽

Odds Ratio ◽

Cox Regression ◽

Postoperative Recurrence ◽

Hazard Ratio ◽

Resection Margins ◽

Time To Recurrence ◽

Increased Risk

Context.— Conflicting data about the clinical significance of microscopic Crohn disease (CD) activity at resection margins have led to varying practice patterns for routine reporting by pathologists. Objective.— To characterize the association between active disease at resection margins with postoperative CD recurrence and time-to-recurrence in the era of anti–tumor necrosis factor therapy. Design.— We performed a multicenter retrospective cohort study of 101 consecutive CD bowel resections during 10 years. Margin slides were reviewed, and CD activity at the margins was graded as none, mild, moderate, or severe. The association between microscopic CD activity at the margin with postoperative recurrence and time-to-recurrence were evaluated with logistic regression and Cox regression analyses, respectively. Results.— Crohn disease activity at resection margins was reported in 43% of pathology reports. Resection margins had CD involvement in 39.6% of cases, 20 of which were classified as mild, 6 as moderate, and 12 with severe CD activity. Although patients with mild (odds ratio, 1.14; 95% CI, 0.40–3.20) and moderate to severe (odds ratio, 1.97; 95% CI, 0.62–6.35) activity were at increased risk of disease recurrence, the differences were not statistically significant. Patients with mild (hazard ratio, 0.97; 95% CI, 0.50–1.91) and moderate to severe (hazard ratio, 1.29; 95% CI, 0.65–2.55) disease activity at margins did not have significantly different time-to-recurrence compared with those without disease activity. Conclusions.— Our study suggests CD activity at resection margins is not significantly associated with postoperative CD recurrence.

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