Guideline adherence for the management of emergency department patients with febrile neutropenia and no infection source: Is there room for improvement?

2020 ◽  
Vol 26 (6) ◽  
pp. 1382-1389
Author(s):  
Brianna Jansma ◽  
Priyanka Vakkalanka ◽  
David A Talan ◽  
Briana Negaard ◽  
Brett A Faine
Keyword(s):  
Emergency Department ◽  
High Risk ◽  
Febrile Neutropenia ◽  
Guideline Adherence ◽  
Risk Group ◽  
Hospital Length ◽  
Low Risk ◽  
Hospital Length Of Stay ◽  
High Risk Patients ◽  
Risk Patients

Introduction Febrile neutropenia is an oncologic emergency associated with significant morbidity and mortality. The objective of our study was to assess guideline adherence and clinical outcomes associated with the management of high- and low-risk febrile neutropenia patients presenting to the emergency department. Methods A retrospective observational cohort study was conducted at a 60,000-visit emergency department at an academically-affiliated tertiary referral hospital. Patients were identified as low- or high-risk using the guideline-recommended Multinational Association for Supportive Care in Cancer score. The primary outcome was the proportion of cases in which the management was concordant with applicable febrile neutropenia guidelines. Guideline adherence was defined as hospital admission and intravenous antimicrobial therapy for high-risk patients and discharge home with oral antimicrobial therapy for low-risk patients. Secondary outcomes included appropriate vancomycin administration, hospital length of stay, rates of acute kidney injury, in-hospital Clostridium difficile infection rates, and 30-day mortality. Results Of the 237 patients included, 94 (39.7%) were low-risk patients and 143 (60.3%) were high-risk patients. Guideline adherence occurred in 96.8% of high-risk patients and 0.4% of low-risk patients. Mean hospital length of stay of the low-risk group was 5 ± 5.0 days compared to 7.2 ± 7.3 days in the high-risk group. Vancomycin was often inappropriately given in 69.5% of high-risk patients. Clostridium difficile occurred in 15 (10.3%) adherent and 4 (4.4%) non-adherent patients. By 30 days, 4 (4.3%) low-risk and 15 (10.7%) high-risk patients died. Conclusion Adherence to the febrile neutropenia guidelines was low resulting in unnecessary hospital admissions of low-risk patients and frequent over-prescription of empirical vancomycin.

P3609Temporal trends of the management and outcomes of patients after myocardial infarction according to the risk for recurrent cardiovascular events

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Grinberg ◽  
T Bental ◽  
Y Hammer ◽  
A R Assali ◽  
H Vaknin-Assa ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
High Risk ◽  
Cardiovascular Events ◽  
Risk Group ◽  
Temporal Trends ◽  
High Risk Group ◽  
Low Risk ◽  
Intermediate Risk ◽  
High Risk Patients ◽  
Risk Patients

Abstract Background Following Myocardial Infarction (MI), patients are at increased risk for recurrent cardiovascular events, particularly during the immediate period. Yet some patients are at higher risk than others, owing to their clinical characteristics and comorbidities, these high-risk patients are less often treated with guideline-recommended therapies. Aim To examine temporal trends in treatment and outcomes of patients with MI according to the TIMI risk score for secondary prevention (TRS2°P), a recently validated risk stratification tool. Methods A retrospective cohort study of patients with an acute MI, who underwent percutaneous coronary intervention and were discharged alive between 2004–2016. Temporal trends were examined in the early (2004–2010) and late (2011–2016) time-periods. Patients were stratified by the TRS2°P to a low (≤1), intermediate (2) or high-risk group (≥3). Clinical outcomes included 30-day MACE (death, MI, target vessel revascularization, coronary artery bypass grafting, unstable angina or stroke) and 1-year mortality. Results Among 4921 patients, 31% were low-risk, 27% intermediate-risk and 42% high-risk. Compared to low and intermediate-risk patients, high-risk patients were older, more commonly female, and had more comorbidities such as hypertension, diabetes, peripheral vascular disease, and chronic kidney disease. They presented more often with non ST elevation MI and 3-vessel disease. High-risk patients were less likely to receive drug eluting stents and potent anti-platelet drugs, among other guideline-recommended therapies. Evidently, they experienced higher 30-day MACE (8.1% vs. 3.9% and 2.1% in intermediate and low-risk, respectively, P<0.001) and 1-year mortality (10.4% vs. 3.9% and 1.1% in intermediate and low-risk, respectively, P<0.001). During time, comparing the early to the late-period, the use of potent antiplatelets and statins increased among the entire cohort (P<0.001). However, only the high-risk group demonstrated a significantly lower 30-day MACE (P=0.001). During time, there were no differences in 1-year mortality rate among all risk categories. Temporal trends in 30-day MACE by TRS2°P Conclusion Despite a better application of guideline-recommended therapies, high-risk patients after MI are still relatively undertreated. Nevertheless, they demonstrated the most notable improvement in outcomes over time.

Screening Efectiveness with SERUM Galactomannan in High and Low Risk Patients for Fungal Infection in the Post ALLO-HTC

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5452-5452
Author(s):  
Fabio Augusto Ruiz Gómez ◽  
Valentin García Gutierrez ◽  
Elia Gomez ◽  
Pilar Herrera Puente ◽  
Isabel Page Herráez ◽  
...  
Keyword(s):  
High Risk ◽  
Fungal Infection ◽  
Hodgkin Lymphoma ◽  
Risk Group ◽  
False Positives ◽  
Low Risk ◽  
Cell Transplant ◽  
Aspergillus Infection ◽  
High Risk Patients ◽  
Risk Patients

Abstract Background and aims: Serum galactomannan (GM) is used as a screening test for the early diagnosis of Aspergillus infection in high risk patients for fungal invasive infection. Serial GM levels analysis have proven to be useful in the high risk clinical setting patients, specially when neutropenic and not receiving anti-mold agents prophylaxis. There is a lack of information regarding the benefit of GM in patients undergoing allogeneic hematopoietic cell transplant (HCT). The aim of this work is to measure the real clinical benefit of the serial periodic determination of GM in the post allo-HCT period. Material and methods: 139 consecutive patients who receivedan allo-HCT (59% related family member donorsand 41% unrelated donors) in our centre for five years (since January 2010 to February 2015) were included in the study. Median age was 46 years. Baseline characteristics of these patients are shown in figure 1. Patients were monitored with GM weekly and received primary prophylaxis with fluconazole since the admission until the immunosuppression was tapered. In order to find a population that could benefit the most for AGA monitoring, we classified our population in low risk patients for invasive fungal infection (IFI) versus high risk patients (those with previous proven or probable IFI or those suffering from GVHD; high risk patients received anti-mold prophyllaxis, mainly with voriconazole or posaconazole). Patients considered as low risk who suffered from Graft versus Host Disease (GVHD) in the ulterior outcome, were censored for low risk and considered as high risk since the development of GVHD, and therefore anti-mold agent prophylaxis was started. GM positivity was determined according standard criteria. When GM positivity was detected, radiological and clinical studies (chest/sinus CT scans, cultures, etc.) to discard Aspegillosis were done as soon as possible. Every patient was followed up prospectively until the last medical consultation or decease. Results: Global overall survival (OS) for the entire cohort was 55.39% and cumulative incidence for severe GVHD grade III/IV was 49.5%. During the follow up, GM became positive in 31/139 (22%) cases. With this approach, the global false positive and false negative rate was 31% and 6% respectively.110/139 (79.14%) patients were identificated as low risk cases. We observed GM positivization in 1.81% (2/110) and 37.18% (29/78) for low and high group respectively. All 2 positive GM in the low risk group were false positives. Regarding the high risk group, 34.48% (10/29) were false positives while in the rest 19 patients (65.52%), subsequent radiological and clinical findings allowed us to diagnose Aspergillus infection (besides they received anti-mold agent prophylaxis). Conclusions: In our experience there is not enough evidence for supporting making serial monitoring with GM in low risk patients for IFI in the post allo-HCT period. However it may be an useful tool in high risk patients. Table 1. N (%) Age (years) Mean 46.18 Median 48.01 Sex (man vs woman) 91 vs 48 (65 vs 35%) Hematology disease Acute Mieloid Leukemia Acute Limphoblastic Leukemia Multiple Myeloma Chronic Mieloid Leukemia Non Hodgkin Lymphoma Hodgkin Lymphoma Others diseases 79 (56.8%) 18 (12.9%) 9 (6.5%) 3 (2.2%) 13 (9.4%) 9 (6.5%) 8 (5.6%) Pre allo-HSCT IFI 17 (12.2%) Aconditioning Myeloablative Reduced Intensity 95 (68.3%) 44 (31.7%) Source of progenitors Peripherical blood Bone marrow 132 (95.0%) 7 (5.0%) Type of donor Related Non-related 82 (59.0%) 57 (41.0%) Graft time (days) Neutrophils (>500 in two consecutive determinations) Platelets (>30.000 in two consecutive determinations) 15.52 17.75 Post-transplant CMV viremia (number of patients with >600 copies in the post-HSCT period) 48 (34.5%) Disclosures No relevant conflicts of interest to declare.

Assessing a prognostic model for predicting VTE occurrence in cancer patients.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1577-1577
Author(s):  
Deesha Sarma ◽  
So Yeon Kim ◽  
David H. Henry
Keyword(s):  
High Risk ◽  
Cancer Patients ◽  
Risk Group ◽  
Low Risk ◽  
Risk Category ◽  
Valuable Insight ◽  
Intermediate Risk ◽  
High Risk Patients ◽  
Prophylactic Measures ◽  
Risk Patients

1577 Background: Venous thromboembolism (VTE) poses a significant health risk to cancer patients and is one of the leading causes of death among this population. The most effective way to prevent VTE and reduce its prominence as a public health burden is by identifying high-risk patients and administering prophylactic measures. In 2008, Khorana et al. developed a model that classified patients by risk based on clinical factors. Methods: We conducted a retrospective study to test this model’s efficacy, on 150 patients with cancer receiving chemotherapy at an outpatient oncology clinic between January 1 and August 1, 2011. We aggregated data and assigned points based on the five factors in the Khorana model: site of cancer with 2 points for very high-risk site and 1 point for high-risk site, 1 point each for leukocyte counts more than 11 x 109/L, platelet counts greater than 350 X 109/L, hemoglobin levels less than 100 g/L and/or the use of erythropoiesis-stimulating agents, and BMI greater than 35 kg/m2 (Khorana et al., Blood 2008). Based on this scoring system, patients with 0 points were grouped into the low-risk category, those with 1-2 points were considered intermediate-risk, and those with 3-4 points were classified as high-risk. Results: As shown in the table, VTE incidence for the low-risk group was 1.9%, intermediate-risk group was 3.9%, and high-risk group was 9.1%. Conclusions: High-risk patients were about 4.5 times more likely to develop a VTE than low risk patients. These results provide valuable insight in determining which patients might benefit from prophylaxis and in motivating the design of prospective clinical trials that assess the VTE predictive model in various ambulatory cancer settings. [Table: see text]

The Effect Of Low Dose Intravenous Heparin On Anti-Factor Xa And Antithrombin III

1981 ◽  
Author(s):  
S A Jennings ◽  
B P Heather ◽  
R M Greenhalgh
Keyword(s):  
High Risk ◽  
Low Dose ◽  
Antithrombin Iii ◽  
Risk Group ◽  
Factor Xa ◽  
Low Risk ◽  
Heparin Infusion ◽  
High Risk Patients ◽  
Intravenous Heparin ◽  
Risk Patients

Preoperative blood samples from 17 patients undergoing major abdominal surgery were examined by the thrombelasto-graph saline dilution test, which has previously been shown to be a predictor of the risk of early postoperative deep vein thrombosis (DVT)(Heather et al 1980). By this test 8 patients were predicted to be at low risk of developing a DVT and received no special prophylaxis. 9 patients were considered to be at risk and were treated with a subcutaneous dose of 1000 units of heparin with the premedication together with a low dose of intravenous heparin infusion from the induction of anaesthesia until 2 hours after operation. Plasma antithrombin III (ATIII) concentration and anti-factor Xa activity were measured preoperatively, on day 1 and on day 3. No early DVT occurred, as assessed by I125 fibrinogen scanning, in either the untreated low risk patients or in the high risk patients receiving heparin infusion. The high risk patients had lower levels of ATIII before operation than the low risk patients (75±9%; 98±39%) and significantly lower levels on day 3 (64±25%; 106±34% p<0.02). However, these lowered levels of ATIII appeared in the high risk group to be augmented by the significant increase in anti-factor Xa activity 127±64%. before operation, 217±89%, on day 1 (p<0.02). Furthermore, on day 3 the high risk patients had significantly greater activity than those patients in the low risk group (212±76%; 106±34% p<0.02).These results show that those patients at risk of developing a postoperative DVT had a significantly enhanced activation of anti-factor Xa, as a result of intravenous low dose heparin with the subsequent abolition of early venous thrombosis.

Risk-stratified systemic surveillance in uveal melanoma

2019 ◽  
pp. bjophthalmol-2018-313569 ◽  
Author(s):  
Jacquelyn M Davanzo ◽  
Elaine M Binkley ◽  
James F Bena ◽  
Arun D Singh
Keyword(s):  
High Risk ◽  
Uveal Melanoma ◽  
Risk Group ◽  
Low Risk ◽  
Risk Level ◽  
High Risk Patients ◽  
Socioeconomic Variables ◽  
Unknown Risk ◽  
Risk Patients ◽  
Socioeconomic Data

Background/AimMolecular prognostication provides clinically applicable prognostic information for patients with uveal melanoma. Most ocular oncologists recommend intensive metastatic surveillance for patients with high-risk tumours. However, socioeconomic variables may limit a patient’s ability to adhere to recommended surveillance. We aim to analyse socioeconomic data from patients with uveal melanoma who underwent molecular prognostication to determine which variables influence adherence.MethodsThis was a retrospective review of 107 consecutive patients who were diagnosed and treated for uveal melanoma from January 2014 to June 2015. Patients were categorised into low/unknown risk and high risk for metastasis. The low-risk group was followed with hepatic ultrasonography every 6 months. The high-risk group was followed with more frequent hepatic imaging or incorporation of hepatic CT/MRI into the surveillance protocol. Adherence to surveillance recommendations was recorded for the first 2 years following primary treatment. Socioeconomic data including age at diagnosis, baseline systemic staging, gene expression profile status, marital status, insurance, distance of primary residence, median household income and Charlson Comorbidity Index score were recorded. Frequency/modality of imaging and metastatic status were also recorded.ResultsHigh-risk patients were more likely to develop metastasis than low-risk/unknown-risk patients (p<0.001). High-risk patients were more likely to have scans at baseline (p=0.008) and to have expected scans relative to low-risk/unknown-risk patients (p<0.001). There was no significant relationship between the likelihood of adhering to recommended surveillance and the other variables analysed.ConclusionsPrognostic risk level is a significant predictor of surveillance and remains significant after adjustment for socioeconomic variables. Adherence to surveillance recommendations for high-risk patients may translate into improved survival.

P6433Use of high-sensitivity cardiac troponin I (hs-cTnI) for secondary prevention in high-risk patients suffering from stable coronary artery disease

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J S Wolter ◽  
S Kriechbaum ◽  
C Troidl ◽  
M Weferling ◽  
K Diouf ◽  
...  
Keyword(s):  
High Risk ◽  
Risk Group ◽  
Stable Coronary Artery Disease ◽  
High Sensitivity ◽  
Low Risk ◽  
High Risk Patients ◽  
Risk Patients ◽  
Artery Disease ◽  
Very High

Abstract Background There are several tools for primary prevention (e.g. Framingham, ESC) that can be used to predict mortality risk in healthy individuals. However, only a few scores have been validated to predict outcome in patients with cardiovascular disease. One of these instruments is the REACH (REduction of Atherothrombosis for Continued Health) score. The ESC guideline for stable coronary artery disease (CAD) places a clear emphasis on carrying out risk stratification before using invasive treatment. Recent studies have revealed a prognostic value of serum hs-cTnI in patients with stable CAD. Purpose The aim of this study was to evaluate the prognostic information provided by hs-cTnI in stable high-risk CAD patients. Methods Between 2011 and 2014, consecutive stable patients with suspected CAD undergoing coronary angiography were included in the study. Data from a 4-year follow-up was obtained; the study endpoint was defined as all-cause mortality. Serum hs-cTnI was measured before angiography using a high-sensitivity assay. Results A total of 3,742 patients were included, of whom 2,274 (60.1%) had confirmed CAD. Patients with an estimated annual mortality rate above 3% using the REACH score were defined as having high risk (n=996 in the low-risk group, n=1,278 in the high-risk cohort). Patients with higher risk were more often male (81.5% vs. 69.2%, p<0.001), were older (mean age 73.2±8.1 y vs. 63±9.4 y), and had more cardiovascular risk factors (diabetes mellitus (DM) 43.5% vs. 13.7%, p<0.001; arterial hypertension 90.8% vs. 86%, p<0.001). Median hs-cTnI was elevated in high-risk patients (6.9 ng/L [IQR 1–3: 3.8–14.8 ng/L] vs. 3 ng/L [IQR 1–3: 1.7–5.9 ng/L]; p<0.001). A total of 298 patients (23.3%) died in the high-risk group compared with 74 patients (7.4%) in the low-risk group. Log(hs-cTnI) was found to be a risk factor based on regression analysis including age, gender, DM, arterial hypertension and the REACH score (OR 2.02 [95% CI 1.61–2.54]). The area under the ROC of hs-cTnI for predicting all-cause mortality was 0.69 (95% CI 0.66–0.72) for hs-cTnI and 0.72 (95% CI 0.69–0.72) for the REACH score. There was a correlation between hs-cTnI and the REACH score (Spearman correlation 0.458; p<0.001). In patients at low risk, the best cut-off for hs-cTnI was 3 ng/L, and for high-risk patients 8.25 ng/L was the best threshold value. Using low REACH score and low hs-cTnI levels, it was possible to identify patients at very low risk with a mortality rate below 3.4% in a follow-up of 48 months. It was also feasible to determine patients at very high risk in the group of patients who were already at high risk using the hs-cTnI cut-off (mortality 15.2% vs. 33.7%). Conclusion Hs-cTnI was found to be an independent risk factor in low- as well as high-risk patients. Hs-cTnI levels correlate with the REACH risk score. Moreover, it was possible to separate patients at very high and very low risk by combining REACH score and hs-cTnI.

scholarly journals Practice-Relevant Revision of Ipset-Thrombosis Based on 1019 Patients with WHO-Defined Essential Thrombocythemia

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4055-4055
Author(s):  
Tiziano Barbui ◽  
Alessandro M. Vannucchi ◽  
Veronika Buxhofer-Ausch ◽  
Valerio De Stefano ◽  
Silvia Betti ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Research Funding ◽  
Risk Group ◽  
Low Risk ◽  
P Value ◽  
Jak2 Mutation ◽  
Risk Status ◽  
High Risk Patients ◽  
Risk Patients

Abstract Background In the recent International Prognostic Score for Thrombosis in essential thrombocythemia (IPSET-thrombosis), age and history of thrombosis were confirmed as independent risk factors for future thrombosis and the study also identified independent prothrombotic role for cardiovascular (CV) risk factors and JAK2 V617F mutation (Barbui et al. Blood 2012). Methods In the current study, we re-analyzed the original IPSET-thrombosis data in 1019 patients with WHO-defined ET in whom JAK2 mutational status was available, in order to quantify the individual contributions of JAK2 mutations and CV risk factors in conventionally-assigned low and high risk ET, as well as in age- versus thrombosis-defined high risk status. Results After a median follow-up of 6.8 and 5.0 years in conventionally-assigned low- and high-risk patients, respectively, the overall annual rate of total thrombosis (108 events) in conventionally-assigned low- and high-risk patients was 1.11%-pt/y (CI 0.81-1.52) and 2.46%-pt/y (CI 1.94-3.11) respectively (p=0.001), and the difference was mainly due to a higher frequency of arterial thrombosis in high-risk patients (p<0.001).The influence of JAK2 mutational status and CV-risk factors on the rate of thrombosis in conventionally assigned low- and high-risk groups is presented in the table. Table 1. Additional risk factors N (%) Event Rate % pts/yr (95% CI) P-value P-value P-value trend Low risk 506 (50) 39 1.11 (0.81-1.52) None 200 (40) 7 0.44 (0.21-0.92) ref Cardiovascular risk factor 36 (7) 3 1.05 (0.34-3.25) 0.220 0.227 JAK2V617F 213 (43) 21 1.59 (1.04-2.44) 0.001 0.217 Both 52 (10) 8 2.57 (1.29-5.15) <0.001 ref <0.001 High risk 513 (50) 69 2.46 (1.94-3.11) None 111 (22) 10 1.44 (0.78-2.68) ref Cardiovascular risk factor 44 (9) 4 1.64 (0.62-4.37) 0.909 0.067 JAK2V617F 222 (43) 30 2.36 (1.65-3.38) 0.168 0.082 Both 136 (27) 25 4.17 (2.82-6.17) 0.011 ref 0.005 The number of major arterial and venous thrombosis was reported as rates per 100 patient-years and the difference among groups was assessed by Mantel Cox log-rank test i) Conventionally-assigned low-risk group. Amongst 506 patients, 200 (40%) displayed neither JAK2 mutation nor CV risk factors and their annual rate of thrombosis was 0.44%, as opposed to 1.05% in the presence of CV risk factors (P=NS), 1.59% in the presence of JAK2 mutation (p=0.001) and 2.57% in the presence of both CV risk factors and JAK2 mutation (P<0.001). There was no significant difference when low-risk patients with both JAK2 mutation and CV risk factors were compared with either those with CV risk factors only (p=0.227) or those with JAK2 mutation only (p=0.217). ii) Conventionally assigned high-risk group: The absence or presence of one or both of the aforementioned additional risk factors for thrombosis were documented in 111 (22%), 44 (9%), 222 (43%) and 136 (27%) patients, respectively, with corresponding annual rates of thrombosis at 1.44%, 1.64%, 2.36% and 4.17% (Table). High-risk patients with both risk factors had a significantly higher risk of thrombosis compared to their counterparts with the absence of JAK2 mutations and CV risk factors (p=0.011). Additional analysis revealed limited enhancement of thrombosis risk by either JAK2 mutations or CV risk factors or both in patients whose high-risk status was defined by the presence of thrombosis history, regardless of age (P=NS). In contrast, the presence of JAK2 mutations, with or without CV risk factors, might have affected thrombosis risk in patients where high-risk status was defined by age alone (p=0.05). Conclusions The current study suggests the possibility of considering four risk categories in ET: "very low risk" group (age ≤60 years and without thrombosis history, JAK2 mutations or CV risk factors); "low risk" (age ≤60 years and without thrombosis history but with JAK2 mutations or CV risk factors); "intermediate risk" (age>60 years but without thrombosis history or JAK2 mutations); and "high risk" (thrombosis history at any age or JAK2 -mutated patients who are older than 60 years of age). Treatment recommendations for each one of the above-mentioned new risk categories should be examined in the context of prospective controlled studies. Disclosures Barbui: Novartis: Speakers Bureau. Vannucchi:Novartis Pharmaceuticals Corporation: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Shire: Speakers Bureau; Baxalta: Membership on an entity's Board of Directors or advisory committees. Buxhofer-Ausch:AOP Orphan: Research Funding. De Stefano:Novartis: Research Funding, Speakers Bureau; Janssen Cilag: Research Funding; Shire: Speakers Bureau; GlaxoSmithKline: Speakers Bureau; Bruno Farmaceutici: Research Funding; Roche: Research Funding; Amgen: Speakers Bureau; Celgene: Speakers Bureau. Gisslinger:Janssen Cilag: Honoraria, Speakers Bureau; AOP ORPHAN: Consultancy, Honoraria, Research Funding, Speakers Bureau; Geron: Consultancy; Sanofi Aventis: Consultancy; Celgene: Consultancy, Honoraria, Research Funding, Speakers Bureau; Novartis: Honoraria, Research Funding, Speakers Bureau.

scholarly journals Multi-Omics Profiling Identifies Risk Hypoxia-Related Signatures for Ovarian Cancer Prognosis

2021 ◽  
Vol 12 ◽  
Author(s):  
Xingyu Chen ◽  
Hua Lan ◽  
Dong He ◽  
Runshi Xu ◽  
Yao Zhang ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
High Risk ◽  
Poor Prognosis ◽  
Cox Regression ◽  
Risk Group ◽  
High Risk Group ◽  
Low Risk ◽  
Cancer Prognosis ◽  
High Risk Patients ◽  
Risk Patients

BackgroundOvarian cancer (OC) has the highest mortality rate among gynecologic malignancy. Hypoxia is a driver of the malignant progression in OC, which results in poor prognosis. We herein aimed to develop a validated model that was based on the hypoxia genes to systematically evaluate its prognosis in tumor immune microenvironment (TIM).ResultsWe identified 395 hypoxia-immune genes using weighted gene co-expression network analysis (WGCNA). We then established a nine hypoxia-related genes risk model using least absolute shrinkage and selection operator (LASSO) Cox regression, which efficiently distinguished high-risk patients from low-risk ones. We found that high-risk patients were significantly related to poor prognosis. The high-risk group showed unique immunosuppressive microenvironment, lower antigen presentation, and higher levels of inhibitory cytokines. There were also significant differences in somatic copy number alterations (SCNAs) and mutations between the high- and low-risk groups, indicating immune escape in the high-risk group. Tumor immune dysfunction and exclusion (TIDE) and SubMap algorithms showed that low-risk patients are significantly responsive to programmed cell death protein-1 (PD-1) inhibitors.ConclusionsIn this study, we highlighted the clinical significance of hypoxia in OC and established a hypoxia-related model for predicting prognosis and providing potential immunotherapy strategies.

Is there a predictive value for measurement of  tumor percentage and the number of tumor foci after prostatectomy?

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 159-159
Author(s):  
Reemt Hinkelammert ◽  
Okyaz Eminaga ◽  
Axel Semjonow
Keyword(s):  
High Risk ◽  
Gleason Score ◽  
Risk Group ◽  
Independent Predictor ◽  
Univariate Analysis ◽  
Specific Antigen ◽  
Low Risk ◽  
Tumour Stage ◽  
High Risk Patients ◽  
Risk Patients

159 Background: The prognostic relevance of tumor volume (TV), tumor percentage (TP) and number of tumor foci (NF) as predictors of biochemical recurrence (BCR) in prostate cancer (PCA) following radical prostatectomy (RPE) is controversial. Methods: The cohort consisted of 758 referred subjects who underwent RPE between 2000 and 2005 at the University of Muenster. The mean time of follow up was 62 months. TV, TP and NF were estimated visually with the assistance of a pathologic mapping grid for embedded RPE specimens. In addition, TV and TP were assessed in a categorized fashion by using medians as cut points. Subgroup analyses for high (i.e. any of the following: > pT2, Gleason score ≥ 8, PSA > 20 ng/ml) and low risk (not high risk) patients were performed. Univariate and multivariate Cox propotional hazard analyses for BCR were performed. Results: TV, TP, and NF were strongly related to tumour stage, Gleason score, surgical margin status (SM) and preoperative prostate specific antigen (PSA). In univariate analysis all pathologic parameters including TV, TP, and NF were predictive for BCR. In multivariate analysis only TP, tumour stage, Gleason score, and PSA level were independent predictors. In subgroup analysis, TP was an independent predictor for BCR in the high risk group, but not in the low risk group. Conclusions: TP, but not TV or NF was found to be an independent predictor for BCR in patients after RPE. TP seems to be more relevant in high risk patients.

Tranexamic acid use in high-risk blood transfusion patients undergoing total hip replacement: a randomised controlled trial

2019 ◽  
pp. 112070001988994
Author(s):  
Osamu S Kimura ◽  
Emílio HCA Freitas ◽  
Maria EL Duarte ◽  
Amanda S Cavalcanti ◽  
Marco BC Fernandes
Keyword(s):  
High Risk ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Risk Group ◽  
Low Risk ◽  
Total Hip ◽  
High Risk Patients ◽  
Risk Patients ◽  
Randomised Controlled

Introduction: We hypothesised that a single preoperative intravenous dose of tranexamic acid (TXA) is effective in patients who undergo total hip arthroplasty (THA) and are at high risk of blood transfusion (preoperative haemoglobin level <13.0 g/dL). Methods: A prospective, randomised controlled study of 308 patients who underwent primary THA was conducted. 256 participants remained in the study and were divided into 2 major groups: high-risk group comprising 116 patients with preoperative Hb < 13.0 g/dL (57 of whom were treated with a 15 mg/kg intravenous bolus of TXA, and 59 of whom did not receive the medication) and low-risk group comprising 140 patients with Hb ⩾ 13.0 g/dL (71 of whom received the same dose of TXA, and 69 of whom did not). Participants were followed up at 3 weeks, 3 months, 6 months, and 1 year after surgery. Results: The use of TXA in both groups of patients significantly increased the levels of postoperative Hb and Ht. TXA protected high-risk patients from blood loss and from transfusion. In low-risk patients the use of TXA reduced blood loss but did not protect from blood transfusion. The median length of stay was significantly affected for high-risk patients. No thromboembolic event was recorded in either group. Conclusions: TXA reduces intra- and postoperative bleeding, transfusion rates, and the length of hospital stays in patients with low preoperative Hb. The use of TXA in patients with normal preoperative Hb reduces blood loss but does not affect the transfusion rate. ClinicalTrials.gov Identifier: NCT03019198

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