Decrease of Mortality during Deferiprone Treatments: Results from A Large Randomised Cohort of Thalassemia Major Patients Under the Auspices of the Italian Society for Thalassemia and Hemoglobinopathies

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3885-3885 ◽  
Author(s):  
Aurelio Maggio ◽  
Angela Vitrano ◽  
Marcello Capra ◽  
Liana Cuccia ◽  
Francesco Gagliardotto ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cox Regression ◽  
Thalassemia Major ◽  
Randomised Clinical Trial ◽  
Hazard Ratio ◽  
Rank Test ◽  
Cardiac Damage ◽  
Treatment Groups ◽  
Log Rank Test

Abstract Prognosis of thalassemia major patients has dramatically improved in the past two decades. Previous papers, including retrospective and prospective non-randomised clinical trials, suggested that mortality, due mainly to cardiac damage, was less or completely absent in patients treated with DFP alone or with associated chelation treatment. For this reason, the main aim of this study was to evaluate whether the addition of deferiprone treatment was also associated with a mortality decrease among a large randomised cohort of thalassemia major patients. Survival analysis was performed among 264 thalassemia major patients assessed for eligibility from 09/30/2000 to 01/31/2008, during a long-term multicentre randomised clinical trial. The reported chelation therapies included sequential DFP-DFO, associated DFP and DFO, DFP and DFO interventions. The survival curves were compared by gender and treatment groups using the long-rank test. Cox regression models were used to explore association between risk for death among treatments and survival time. All statistical analyses were performed by STATA 9.2. All these patients performed DFO before the date of randomisation. One death was due to a graft versus host disease (GVHD) in a patient underwent bone marrow transplantation and this patient was censored at the time of transplant. The improved survival for sequential DFP-DFO, DFP-alone, and associated DFP-DFO treated patients versus DFO-treated was statistically significant (log-rank test, χ2= 18.64; p≤0.01). In fact, no deaths were reported during DFP-alone and DFP-DFO associated treatments along a 564.5 person-years period of observation. Only one death was reported during DFP-DFO sequential treatment in a patient who had experienced 1-year before an episode of heart failure. All other ten deaths were among patients under DFO treatment. The hazard ratio for death of DFO treatment versus other treatments was 27.78 (p= 0.002). The main factors correlated with increased hazard ratio for death were cirrhosis, arrhythmia, previous episode of heart failure, diabetes, hypogonadism, hypothyroidism. No correlation between serum ferritin levels and hazard ratio for death was found. These results confirm as deferiprone alone or in addition to deferoxamine intervention is able to reduce mortality in thalassemia major patients probably because of its specific cardioprotective effect occurring independently from body iron overloading

124Impact of intimal tracking for recanalization of CTO lesions on long-term clinical outcomes

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Kano ◽  
K Nasu ◽  
M Habara ◽  
T Shimura ◽  
M Yamamoto ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Cox Regression ◽  
Target Lesion ◽  
Hazard Ratio ◽  
Rank Test ◽  
Total Occlusion ◽  
Significant Difference ◽  
The Impact

Abstract Background For recanalization of coronary chronic total occlusion (CTO) lesions, subintimal guidewire tracking in both antegrade and retrograde approaches are commonly used. Purpose This study aimed to assess the impact of subintimal tracking on long-term clinical outcomes after recanalization of CTO lesions. Methods Between January 2009 and December 2016, 474 CTO lesions (434patients) were successfully recanalized in our center. After guidewire crossing in a CTO lesion, those lesions were divided into intimal tracking group (84.6%, n=401) and subintimal tracking group (15.4%, n=73) according to intravascular ultrasound (IVUS) findings. Long-term clinical outcomes including death, target lesion revascularization (TLR), target vessel revascularization (TVR) were compared between the two groups. In addition, the rate of re-occlusion after successful revascularization was also evaluated. Results The median follow-up period was 4.7 years (interquartile range, 2.8–6.1). There was no significant difference of the rate of cardiac death between the two groups (intimal tracking vs. subintimal tracking: 7.0% vs. 4.1%; hazard ratio, 0.61; 95% confidence interval [CI], 0.19 to 2.00; p=0.41), TLR (14.3% vs. 16.2%; hazard ratio, 1.34; 95% CI, 0.71 to 2.53; p=0.37), and TVR (17.5% vs. 20.3%; hazard ratio, 1.27; 95% CI, 0.72 to 2.23; p=0.42). However, the rate of re-occlusion was significantly higher in the subintimal tracking group than intimal tracking group at 3-years re-occlusion (4.2% vs. 14.5%; log-rank test, p=0.002, Figure). In the multivariate COX regression, subintimal guidewire tracking was an independent predictor of re-occlusion after CTO recanalization (HR: 5.40; 95% CI: 2.11–13.80; p<0.001). Figure 1 Conclusions Subintimal guidewire tracking for recanalization of coronary CTO was associated with significantly higher incidence of target lesion re-occlusion during long-term follow-up period.

scholarly journals Reopening of an obstructed third ventriculostomy: long-term success and factors affecting outcome in 215 infants

2015 ◽  
Vol 15 (4) ◽  
pp. 399-405 ◽  
Author(s):  
Paul J. Marano ◽  
Scellig S. D. Stone ◽  
John Mugamba ◽  
Peter Ssenyonga ◽  
Ezra B. Warf ◽  
...  
Keyword(s):  
Cox Regression ◽  
Operation Time ◽  
Cox Proportional Hazards Model ◽  
Wilcoxon Test ◽  
Rank Test ◽  
Third Ventriculostomy ◽  
Time To Failure ◽  
Factors Affecting ◽  
Log Rank Test

OBJECT The role of reopening an obstructed endoscopic third ventriculostomy (ETV) as treatment for ETV failure is not well defined. The authors studied 215 children with ETV closure who underwent successful repeat ETV to determine the indications, long-term success, and factors affecting outcome. METHODS The authors retrospectively reviewed the CURE Children's Hospital of Uganda database from August 2001 through December 2012, identifying 215 children with failed ETV (with or without prior choroid plexus cauterization [CPC]) who underwent reopening of an obstructed ETV stoma. Treatment survival according to sex, age at first and second operation, time to failure of first operation, etiology of hydrocephalus, prior CPC, and mode of ETV obstruction (simple stoma closure, second membrane, or cisternal obstruction from arachnoid scarring) were assessed using the Kaplan-Meier survival method. Survival differences among groups were assessed using log-rank and Wilcoxon methods and a Cox proportional hazards model. RESULTS There were 125 boys and 90 girls with mean and median ages of 229 and 92 days, respectively, at the initial ETV. Mean and median ages at repeat ETV were 347 and 180 days, respectively. Postinfectious hydrocephalus (PIH) was the etiology in 126 patients, and nonpostinfectious hydrocephalus (NPIH) in 89. Overall estimated 7-year success for repeat ETV was 51%. Sex (p = 0.46, log-rank test; p = 0.54, Wilcoxon test), age (< vs > 6 months) at initial or repeat ETV (p = 0.08 initial, p = 0.13 repeat; log-rank test), and type of ETV obstruction (p = 0.61, log-rank test) did not affect outcome for repeat ETV (p values ≥ 0.05, Cox regression). Those with a longer time to failure of initial ETV (> 6 months 91%, 3–6 months 60%, < 3 months 42%, p < 0.01; log-rank test), postinfectious etiology (PIH 58% vs NPIH 42%, p = 0.02; log-rank and Wilcoxon tests) and prior CPC (p = 0.03, log-rank and Wilcoxon tests) had significantly better outcome. CONCLUSIONS Repeat ETV was successful in half of the patients overall, and was more successful in association with later failures, prior CPC, and PIH. Obstruction of the original ETV by secondary arachnoid scarring was not a negative prognostic factor, and should not discourage the surgeon from proceeding. Repeat ETV may be a more durable solution to failed ETV/CPC than shunt placement in this context, especially for failures at more than 3 months after the initial ETV. Some ETV closures may result from an inflammatory response that is less robust at the second operation.

scholarly journals Telemonitoring in patients with heart failure: Is there a long-term effect?

2017 ◽  
Vol 25 (3) ◽  
pp. 158-166 ◽  
Author(s):  
Arno J Gingele ◽  
Hanspeter Brunner-la Rocca ◽  
Bram Ramaekers ◽  
Anton Gorgels ◽  
Gerjan De Weerd ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Admission ◽  
Rank Test ◽  
Long Term Effects ◽  
Long Term Outcome ◽  
Log Rank Test ◽  
Significant Difference ◽  
All Cause Mortality

Introduction Evidence suggests that telemonitoring decreases mortality and heart failure (HF)-related hospital admission in patients with HF. However, most studies follow their patients for only several months. Little is known about the long-term effects of telemonitoring after a period of application. Methods In 2007, the TEHAF study was initiated to compare tailored telemonitoring with usual care with respect to time until first HF-related hospital admission. In total, 301 patients completed the study after a follow-up period of one year. No differences could be found in time to first HF-related admission between intervention and control groups. Here, we performed a retrospective analysis in order to investigate potential long-term effects of telemonitoring. The primary endpoint was time to first HF-related hospital admission. Secondary endpoints were, amongst others, all-cause mortality, hospital admission due to HF and days alive and out of hospital (DAOOH). Electronic files of all included patients were reviewed between October 2007 and September 2015. Result Mean follow-up duration was 1652 days (standard deviation: 1055 days). No significant difference in time to first HF-related hospital admission (log-rank test, p = 0.15), all-cause mortality (log-rank test, p = 0.43), or DAOOH (two-sample t-test, p = 0.87) could be found. However, patients that underwent telemonitoring had significantly fewer HF-related hospital admissions (incident rate ratio 0.54, 95% confidence interval 0.31–0.88). Discussion Telemonitoring did not significantly influence the long-term outcome in our study. Therefore, extending the follow-up period of telemonitoring studies in HF patients is probably not beneficial.

Stem Cell Mobilization With Plerixafor + G-CSF In Comparison To Cyclophosphamide + G-CSF and Time-To-Progression After Autologous Stem Cell Transplantation For Multiple Myeloma

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 3354-3354
Author(s):  
Alfred L. Garfall ◽  
Andrew Dougherty ◽  
Dan T. Vogl ◽  
Brendan M Weiss ◽  
Adam D Cohen ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Maintenance Therapy ◽  
Cox Regression ◽  
Hazard Ratio ◽  
Rank Test ◽  
Hematopoietic Stem ◽  
Log Rank Test ◽  
Induction Regimen ◽  
Cell Mobilization

Abstract Background G-CSF in combination with either cyclophosphamide (G-Cy) or plerixafor (G-P) safely mobilizes hematopoietic stem cells of adequate quality and quantity for auto-SCT in patients with multiple myeloma. Few studies have examined the impact of mobilization regimen on post-transplant disease control, particularly since the availability of plerixafor. Methods We retrospectively compared time-to-progression (TTP) after single melphalan-conditioned (140-200 mg/m2) auto-SCT in a single-institution cohort in which stem cells were mobilized with either cyclophosphamide 3 gm/m2 + G-CSF 10 mcg/kg/day x 10-14 days (G-Cy, n=93) or G-CSF 10 mcg/kg/day x 5-9 days with addition of plerixafor 240 mcg/kg/day starting on day 5 (G-P, n=55). Choice of mobilization regimen was according to physician preference. All patients had symptomatic multiple myeloma and had completed induction therapy with a regimen containing bortezomib and/or lenalidomide/thalidomide. Transplants conducted from January 2010 to May 2013, when commercially-available plerixafor was first used at our institution, were included in the analysis. Patients receiving tandem or salvage transplants and patients receiving investigational therapies in conjunction with transplant were excluded. Maintenance therapy was prescribed at the discretion of the treating physician. Progression was scored according to IMWG criteria. Results The G-Cy and G-P cohorts were well matched for age, gender, and baseline multiple myeloma prognostic factors (see table). Cytogenetic data and beta-2-microglobulin measurements were not consistently available at baseline. Patients receiving G-P were more likely to have a >60 day interval between mobilization and transplant (P<0.0001) and >1 year interval between diagnosis and transplant (P=0.05). At time of transplant, hemoglobin was lower in the G-Cy group (P=0.0003), and platelet count was lower in the G-P group (P=0.035). Renal function at time of transplant was similar between the two groups. Patients in the G-P group were more likely to have received dose-reduced melphalan (<200 mg/m2) (p=0.03). The G-P group had higher ALC at day +15, which has been reported previously as a favorable prognostic factor for progression-free and overall survival. Median follow-up was 22 months. TTP was significantly different in the two groups (p=0.0095, log-rank test); median TTP was 25 months in the G-Cy group vs. 13 months in the G-P group (see figure). The difference in TTP remained significant when patients were excluded from the analysis who were transplanted more than 1 year after diagnosis (median TTP 26 vs. 13 months, P=0.0136 by log-rank test) or who were transplanted more than 60 days after mobilization (TTP 25 vs 13 months, P=0.0017 by log-rank test). Other variables that were significantly correlated with inferior TTP included IgA isotype (p=0.022) and receipt of >1 induction regimen (p=0.0077). In a univariate Cox regression, mobilization with G-P was associated with a hazard ratio of 2.1 (95% CI 1.2-3.9, p=0.011) for progression. In a multivariate Cox regression incorporating presence of IgA isotype, receipt of >1 induction regimen, mobilization regimen, age at transplant, time from diagnosis to transplant, time from mobilization to transplant, receipt of reduced melphalan dose, creatinine/hemoglobin/platelet count at time of transplant, ALC on day +15, and receipt of maintenance therapy, the association between G-P and inferior TTP was preserved (hazard ratio 2.8, 95% CI 1.3-6.0, p=0.007). The only other statistically significant variable was receipt of >1 induction regimen (hazard ratio 2.3, 95% CI 1.3-4.4, p=0.008). Receipt of maintenance therapy had a protective effect that approached statistical significance (hazard ratio 0.58, 95% CI 0.33-1.03, P=0.065). There were no significant differences in overall survival between the G-Cy and G-P groups. Conclusion Hematopoietic stem cell mobilization with G-P was associated with significantly shorter post-transplant TTP compared to G-Cy in this single-institution cohort of multiple myeloma patients. We cannot conclude whether this association is due to effects of the mobilization regimen or confounding variables not accounted for in our analysis. This association warrants examination in a larger, multi-institution cohort. Disclosures: Stadtmauer: Sanofi: Consultancy.

Safety and efficacy of bevacizumab biosimilar in glioma.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14541-e14541
Author(s):  
Gunjesh Kumar Singh ◽  
Hollis D'souza ◽  
Sujay Srinivas ◽  
Dilip Harindran Vallathol ◽  
Mounika Boppana ◽  
...  
Keyword(s):  
Clinical Efficacy ◽  
Cox Regression ◽  
Low Cost ◽  
Progression Free Survival ◽  
Hazard Ratio ◽  
Recurrent Glioma ◽  
Rank Test ◽  
P Value ◽  
Cox Regression Analysis ◽  
Log Rank Test

e14541 Background: Anti-VEGF antibody Bevacizumab (Avastin: Roche Pharma AG) is the recommended drug for recurrent glioma. Multiple low-cost bio-similars of this drug are now available however their clinical efficacy has never been compared against the original molecule. The aim of the current analysis is to compare the overall survival (OS) between recurrent glioma patients with bio-similar and innovator molecule. Methods: Adult recurrent glioma patients treated with bevacizumab from 1st July 2015 to 30th July 2019 were identified from the Neuro-Medical Oncology database. These patients were either offered Avastin or Bevacizumab biosimilar (BevaciRel: Reliance Life sciences or Bryta: Zydus Oncosciences) depending upon the financial affordability. The primary endpoint of the study was OS. It was defined as the time in months from the start of bevacizumab to death. Progression-free survival (PFS) was defined as the time in months from the start of bevacizumab to progression or death. The time to event variables was estimated using Kaplan Meier method. The median with its 95% confidence interval (CI) was calculated using Brookmeyer and Crowley method. The estimates were compared between the original and bio-similar bevacizumab cohort using the log-rank test. The hazard ratio was calculated using COX regression analysis. Results: There were 82 patients, out of which 57 received innovator and 25 received bio-similar bevacizumab. At median follow up of 26 months, 76 patients had an event for progression. The median PFS was 3.66 (95% CI 2.08 to 5.25) and 3.3 months (95% CI 2.38 to 4.21) in innovator and bio-similar arm respectively (Log-rank test P-value = 0.072). The hazard ratio for progression was 0.61 (95% CI 0.35 to 1.05; P-value = 0.075). At the time of data cutoff, there were 69 deaths. The median OS was 5.53 (95% CI, 5.07 to 5.99) vs 7.33 months (95% CI, 5.63 to 9.03) in innovator and bio-similar arm respectively (Log-rank test P-value = 0.51). The hazard ratio for death was 1.21 (95% CI, 0.67 to 2.17; p-value = 0.51). Conclusions: In the brain tumor patients, both innovator and bio-similar bevacizumab seem to have similar clinical efficacy.

scholarly journals Peran Bersihan Laktat pada Kesintasan Pasien Sepsis Berat

2016 ◽  
Vol 3 (1) ◽  
pp. 38
Author(s):  
Wirawan Hambali ◽  
Lie Khie Chen ◽  
Djoko Widodo ◽  
Esthika Dewiasty ◽  
Herdiman T Pohan ◽  
...  
Keyword(s):  
Survival Rate ◽  
Mortality Rate ◽  
Regression Model ◽  
Median Survival ◽  
Cox Regression ◽  
Lactate Clearance ◽  
Hazard Ratio ◽  
Rank Test ◽  
Log Rank Test ◽  
High Lactate

Pendahuluan. Sepsis Berat merupakan masalah kesehatan dengan tingkat mortalitas yang tinggi serta insiden yang terus meningkat. Bersihan laktat menggambarkan kinetika metabolisme anaerob pasien sepsis berat dan merupakan parameter yang potensial untuk mengevaluasi kondisi penyakit dan intervensi pengobatan yang didapat pasien. Namun demikian, hubungan antara bersihan laktat terhadap terjadinya kematian pasien sepsis berat belum diketahui. Berdasarkan hal tersebut, penelitian ini dilakukan untuk mengetahui pengaruh bersihan laktat terhadap kesintasan pasien dengan sepsisberat, serta faktor-faktor perancu yang mempengaruhi hubungan tersebut.Metode. Penelitian ini merupakan penelitian kohort prospektif yang dilaksanakan di Unit Gawat Darurat dan ruang perawatan Rumah Sakit dr. Cipto Mangunkusumo (RSCM) pada bulan Maret-Mei 2011. Pasien termasuk dalam kelompok bersihan laktat tinggi bila terdapat perbedaan kadar laktat ≥10% dalam 6 jam pertama pengobatan, sedangkan perbedaan <10% termasuk ke dalam kelompok bersihan laktat rendah. Selanjutnya, dilakukan observasi terhadap terjadinya kematian dalam 10 hari pertama perawatan pada kedua kelompok. Data yang terkumpul selanjutnya dianalisis mengunakan uji statistik log-rank test, serta dicari nilai hazard ratio dengan menggunakan uji cox regression model. Selanjutnya, dilakukan analisis variabel perancu dengan menggunakan uji cox regression.Hasil. Laju kesintasan kelompok bersihan laktat tinggi dan rendah masing-masing sebesar 60,0% dan 26,7% (p=0,004). Median kesintasan yaitu 3 hari pada bersihan laktat rendah, sedangkan kematian tidak mencapai 50% pada bersihan laktat tinggi. Interkuartil I kedua kelompok berturut-turut sebesar 1 dan 4 hari. Dari analisis didapatkan hazard ratio sebesar 2,87 (IK 95%; 1,41-5,83). Pada analisis multivariat keberadaan syok sepsis, skor SOFA, penggunaan vasopresor/inotropik, transfusi dan cairan resusitasi, tidak ada yang mengubah nilai hazard ratio >10%. Oleh karena itu, tidak ada yang memenuhi syarat untuk disebut sebagai perancu.Simpulan. Pasien bersihan laktat tinggi memiliki kesintasan lebih tinggi dibandingkan pasien bersihan laktat rendah dan hubungan tersebut tidak dipengaruhi perancu. Kata Kunci: bersihan laktat, kesintasan, sepsis berat The Role of Lactate Clearance in Severe Septic Patients SurvivalIntroduction. Severe Sepsis is a major health problem that known to results high mortality rate, and still its incidents continue to rise. Lactate clearance represents kinetics alteration of anaerobic metabolism in severe septic patients that makes it to become a potential parameter to evaluate severity of one’s illness and intervention adequacy that received by the patient. However, the relationship between lactate clearance and occurrence of death in severe septic patients is still unknown.Methods. This is a prospective cohort study that conducted in Ciptomangunkusumo Hospital, from March to May 2011. Patients were categorized into high lactate clearance group if there were differences in lactate levels ≥ 10% in which occurred within the first 6 hours of the treatment, and contrary were categorized into low lactate clearance group. Occurrences of death were observed within the first 10 days. Afterward, the data were analyzed by means of survival analysis, Kapplan Meier curve were made, survival rate and median survival rate were determined, statistical test were calculated using log-rank test, and hazard ratios were calculated using Cox regression model test. Analysis of Confounder Variable was also performed using multivariate Cox regression testResults. The survival rate for high and low lactate clearance group were 60.0% vs. 26.7%, respectively (p=0,004). In low lactate clearance group the median survival was 3 days, while the mortality rate did not reach 50% in high lactate clearance group. The first Interquartile for these two groups was 1 day and 4 days, respectively. The hazard ratio that obtained from the analysis was 2.87 (95% CI, 1.41 - 5.83). On multivariate analysis the presence of septic shock, SOFA score, the use of vasopresor/inotropic, blood transfusion, fluid resuscitation didn’t change the hazard ratio value more than 10%. For that reason, these parameters were not considered as confounder.Conclusions. Patients with high lactate clearance have a better survival rate compared to patients with low lactate clearance, and its relationship is not influenced by confounder.

P3520Admission hyperglycemia is a predictor of mortality of acute heart failure: comparison between patients with and without diabetes mellitus

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Y Cho ◽  
K H Kim ◽  
S E Lee ◽  
H Y Lee ◽  
J O Choi ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Clinical Outcomes ◽  
Acute Heart Failure ◽  
Independent Predictor ◽  
Rank Test ◽  
Log Rank Test ◽  
The Impact

Abstract Background Regardless of diabetes mellitus (DM), admission hyperglycemia is not uncommon in patients with acute heart failure (AHF). Although DM is a well-known predictor of mortality in AHF, the impacts of admission hyperglycemia on clinical outcomes in non-DM patients with AHF have been poorly studied. The aim of this study, therefore, was to compare the impact of admission hyperglycemia on long-term clinical outcomes in AHF patients with or without DM. Methods Among 5,625 AHF patients enrolled in a nationwide registry, a total of 5,541 patients were enrolled and divided into 2 groups; DM group (n=2,125, 70.4±11.4 years) vs. non-DM group (n=3,416, 67.3±16.0 years). Each group were further divided into 2 groups according to the presence of admission hyperglycemia (admission serum glucose level >200mg/dl); admission hyperglycemia (n=248) and no hyperglycemia (n=3,168) in non-DM; admission hyperglycemia (n=799) and no hyperglycemia (n=1,326) in DM. All-cause death and hospitalization due to HF (HHF) during 1-year follow-up were compared. Results Death was developed in 1,220 patients (22.2%) including 269 inhospital deaths (4.9%) during 1-year of follow-up. Death rate were significantly higher in DM than in non-DM group (24.8% vs 20.5%, p<0.001), however there was no difference in inhospital death (5.1% vs 4.7%, p=0.534). Both inhospital death (7.6% vs. 4.2%, p<0.001) and 1-year death (26.2% vs. 21.3%, p=0.001) were more frequent in AHF patients with hyperglycemia. On Kaplan-Meier survival curve analysis, however, admission hyperglycemia was associated with significantly higher death (p<0.001 by log-rank test) and rehospitalization (p=0.006 by log-rank test) in non-DM group, but not in DM group. In non-DM group, admission hyperglycemia was an independent predictor of 1-year mortality (HR 1.46, 95% CI 1.10–1.93, p=0.009). Conclusion DM was a significant predictor of long-term mortality in patients with AHF. Admission hyperglycemia was associated with both higher inhospital and 1-year mortality. The present study also demonstrated that admission hyperglycemia is an independent predictor of mortality in non-DM patients with AHF, but not in DM patients. In addition to the presence of DM, admission hyperglycemia would be a useful marker in the risk stratification of AHF, especially in non-DM patients.

scholarly journals Predictive impact of PVL assessments on clinical outcomes in patients undergoing TAVR

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Matsushita ◽  
B Marchandot ◽  
M Kibler ◽  
C Sato ◽  
J Heger ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Cox Regression ◽  
Adenosine Diphosphate ◽  
Rank Test ◽  
Multicenter Studies ◽  
Cox Regression Analysis ◽  
Paravalvular Leakage ◽  
Transcatheter Aortic Valve ◽  
Log Rank Test ◽  
Cerebrovascular Events

Abstract Introduction Paravalvular leakage (PVL) following transcatheter aortic valve replacement (TAVR) is associated with greater mortality. In clinical practice, determining PVL severity after TAVR remains challenging and often requires multiparametric assessment. Purpose This study sought to evaluate the respective value of various modalities of PVL assessments, including transthoracic echocardiography (TTE), cine-angiography, aortic regurgitation index (ARI), and closure time with adenosine diphosphate (CT-ADP), in the prediction of adverse clinical outcomes. Methods We included 1044 patients from our prospective TAVR registry between February 2010 and May 2019. Major adverse cardiac and cerebrovascular events (MACCE) was defined as a composite of all-cause death, myocardial infarction, stroke, and heart failure hospitalization within 1-year. Established cutoff values of ARI (&lt;25) and CT-ADP (&gt;180 sec) were used to assess the presence of PVL after TAVR. Results Moderate to severe PVL occurred in 14.2% and 5.2% of patients as measured by TTE and angiography. The rate of patients with ARI &lt;25 and CT-ADP &gt;180 sec were 36.5% and 24.9%, respectively. Among the four modalities, PVL evaluated by angiography predicted poorer clinical outcomes (Log rank test; p=0.001), whereas TTE, ARI &lt;25, and CT-ADP &gt;180 sec were not associated with 1-year MACCE. By multivariate Cox regression analysis, moderate to severe PVL by angiography was an independent predictor of 1-year MACCE (hazard ratio: 1.96; 95% confidence interval: 1.22–3.00; p=0.007). Conclusions Paravalvular leakage measured by angiography was evidenced as the most meaningful modality in the prediction of adverse clinical outcomes. Future multicenter studies are warranted to ensure these findings in the current TAVR era. Figure 1 Funding Acknowledgement Type of funding source: None

Survival Outcomes for Induction vs Adjuvant Chemotherapy in Squamous Cell Carcinoma of the Maxillary Sinus

2018 ◽  
Vol 160 (4) ◽  
pp. 658-663 ◽  
Author(s):  
Phoebe Kuo ◽  
Sina J. Torabi ◽  
Dennis Kraus ◽  
Benjamin L. Judson
Keyword(s):  
Overall Survival ◽  
Adjuvant Chemotherapy ◽  
Maxillary Sinus ◽  
Induction Chemotherapy ◽  
Squamous Cell ◽  
Cox Regression ◽  
Rank Test ◽  
Controlled Clinical Trial ◽  
Log Rank Test ◽  
Kaplan Meier

Objective In advanced maxillary sinus cancers treated with surgery and radiotherapy, poor local control rates and the potential for organ preservation have prompted interest in the use of systemic therapy. Our objective was to present outcomes for induction compared to adjuvant chemotherapy in the maxillary sinus. Study Design Secondary database analysis. Setting National Cancer Database (NCDB). Subjects and Methods In total, 218 cases of squamous cell maxillary sinus cancer treated with surgery, radiation, and chemotherapy between 2004 and 2012 were identified from the NCDB and stratified into induction chemotherapy and adjuvant chemotherapy cohorts. Univariate Kaplan-Meier analyses were compared by log-rank test, and multivariate Cox regression was performed to evaluate overall survival when adjusting for other prognostic factors. Propensity score matching was also used for further comparison. Results Twenty-three patients received induction chemotherapy (10.6%) and 195 adjuvant chemotherapy (89.4%). The log-rank test comparing induction to adjuvant chemotherapy was not significant ( P = .076). In multivariate Cox regression when adjusting for age, sex, race, comorbidity, grade, insurance, and T/N stage, there was a significant mortality hazard ratio of 2.305 for adjuvant relative to induction chemotherapy (confidence interval, 1.076-4.937; P = .032). Conclusion Induction chemotherapy was associated with improved overall survival in comparison to adjuvant chemotherapy in a relatively small cohort of patients (in whom treatment choice cannot be characterized), suggesting that this question warrants further investigation in a controlled clinical trial before any recommendations are made.

scholarly journals Evaluation of different late left ventricular remodeling definitions for predicting long-term outcomes in acute myocardial infarction patients undergoing percutaneous coronary intervention

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Zhang ◽  
X Xie ◽  
C He ◽  
X Lin ◽  
M Luo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ventricular Remodeling ◽  
Cox Regression ◽  
Left Ventricular Remodeling ◽  
Left Ventricular ◽  
Long Term Outcomes ◽  
Cox Regression Analysis ◽  
Long Term Mortality

Abstract Background Late left ventricular remodeling (LLVR) after the index acute myocardial infarction (AMI) is a common complication, and is associated with poor outcome. However, the optimal definition of LLVR has been debated because of its different incidence and influence on prognosis. At present, there are limited data regarding the influence of different LLVR definitions on long-term outcomes in AMI patients undergoing percutaneous coronary intervention (PCI). Purpose To explore the impact of different definitions of LLVR on long-term mortality, re-hospitalization or an urgent visit for heart failure, and identify which definition was more suitable for predicting long-term outcomes in AMI patients undergoing PCI. Methods We prospectively observed 460 consenting first-time AMI patients undergoing PCI from January 2012 to December 2018. LLVR was defined as a ≥20% increase in left ventricular end-diastolic volume (LVEDV), or a &gt;15% increase in left ventricular end-systolic volume (LVESV) from the initial presentation to the 3–12 months follow-up, or left ventricular ejection fraction (LVEF) &lt;50% at follow up. These parameters of the cardiac structure and function were measuring through the thoracic echocardiography. The association of LLVR with long-term prognosis was investigated by Cox regression analysis. Results The incidence rate of LLVR was 38.1% (n=171). The occurrence of LLVR according to LVESV, LVEDV and LVEF definition were 26.6% (n=117), 31.9% (n=142) and 11.5% (n=51), respectively. During a median follow-up of 2 years, after adjusting other potential risk factors, multivariable Cox regression analysis revealed LLVR of LVESV definition [hazard ratio (HR): 2.50, 95% confidence interval (CI): 1.19–5.22, P=0.015], LLVR of LVEF definition (HR: 16.46, 95% CI: 6.96–38.92, P&lt;0.001) and LLVR of Mix definition (HR: 5.86, 95% CI: 2.45–14.04, P&lt;0.001) were risk factors for long-term mortality, re-hospitalization or an urgent visit for heart failure. But only LLVR of LVEF definition was a risk predictor for long-term mortality (HR: 6.84, 95% CI: 1.98–23.65, P=0.002). Conclusions LLVR defined by LVESV or LVEF may be more suitable for predicting long-term mortality, re-hospitalization or an urgent visit for heart failure in AMI patients undergoing PCI. However, only LLVR defined by LVEF could be used for predicting long-term mortality. FUNDunding Acknowledgement Type of funding sources: None. Association Between LLVR and outcomes Kaplan-Meier Estimates of the Mortality

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