Thrombocytopenia predicts mortality in Chinese hemodialysis patients- an analysis of the China DOPPS

Abstract Background Hemodialysis (HD) patients have a higher mortality rate compared with general population. Our previous study revealed that platelet counts might be a potential risk factor. The role of platelets in HD patients has rarely been studied. The aim of this study is to examine if there is an association of thrombocytopenia (TP) with elevated risk of all-cause mortality and cardiovascular (CV) death in Chinese HD patients. Methods Data from a prospective cohort study, China Dialysis Outcomes and Practice Patterns Study (DOPPS) 5, were analyzed. Demographic data, comorbidities, platelet counts and other lab data, and death records which extracted from the medical record were analyzed. TP was defined as the platelet count below the lower normal limit (< 100*109/L). Associations between platelet counts and all-cause and CV mortality were evaluated using Cox regression models. Stepwise multivariate logistic regression was used to identify the independent associated factors, and subgroup analyses were also carried out. Results Of 1369 patients, 11.2% (154) had TP at enrollment. The all-cause mortality rates were 26.0% vs. 13.3% (p < 0.001) in patients with and without TP. TP was associated with higher all-cause mortality after adjusted for covariates (HR:1.73,95%CI:1.11,2.71), but was not associated with CV death after fully adjusted (HR:1.71,95%CI:0.88,3.33). Multivariate logistic regression showed that urine output < 200 ml/day, cerebrovascular disease, hepatitis (B or C), and white blood cells were independent impact factors (P < 0.05). Subgroup analysis found that the effect of TP on all-cause mortality was more prominent in patients with diabetes or hypertension, who on dialysis thrice a week, with lower ALB (< 4 g/dl) or higher hemoglobin, and patients without congestive heart failure, cerebrovascular disease, or hepatitis (P < 0.05). Conclusion In Chinese HD patients, TP is associated with higher risk of all-cause mortality, but not cardiovascular mortality. Platelet counts may be a useful prognostic marker for clinical outcomes among HD patients, though additional study is needed.

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Physical Function and Clinical Outcomes in Hemodialysis Patients: China Dialysis Outcomes and Practice Patterns Study

Kidney Diseases ◽

10.1159/000513897 ◽

2021 ◽

pp. 1-8

Author(s):

Qingyu Niu ◽

Xinju Zhao ◽

Liangying Gan ◽

Xinling Liang ◽

Zhaohui Ni ◽

...

Keyword(s):

Physical Function ◽

Clinical Outcomes ◽

Practice Patterns ◽

Cox Regression ◽

Demographic Data ◽

Simple Method ◽

Daily Dialysis ◽

All Cause Mortality ◽

Dialysis Outcomes ◽

Climbing Stairs

Background: Hemodialysis (HD) patients usually have impaired physical function compared with the general population. Self-reported physical function is a simple method to implement in daily dialysis care. This study aimed to examine the association of self-reported physical function with clinical outcomes of HD patients. Methods: The Dialysis Outcomes and Practice Patterns Study (DOPPS) is a prospective cohort study. Data on 1,427 HD patients in China DOPPS5 were analyzed. Self-reported physical function was characterized by 2 items of “moderate activities limited level” and “climbing stairs limited level.” Demographic data, comorbidities, hospitalization, and death records were collected from patients’ records. Associations between physical function and outcomes were analyzed using COX regression models. Results: Compared to “limited a lot” in moderate activities, “limited a little” and “not limited at all” groups were associated with lower all-cause mortality after adjusted for covariates (HR: 0.652, 95% CI: 0.435–0.977, and HR: 0.472, 95% CI: 0.241–0.927, respectively). And, not limited in moderate activities was associated with lower risk of hospitalization than the “limited a lot” group after adjusted for covariates (HR: 0.747, 95% CI: 0.570–0.978). Meanwhile, compared to “limited a lot” in climbing stairs, “limited a little” and “not limited at all” groups were associated with lower all-cause mortality (HR: 0.574, 95% CI: 0.380–0.865 and HR: 0.472, 95% CI: 0.293–0.762, respectively) but not hospitalization after fully adjusted. Conclusion: Higher limited levels in self-reported physical function were associated with higher risk of all-cause mortality and hospitalization in HD patients.

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Physical Function and Clinical Outcomes in Hemodialysis Patients: The China Dialysis Outcomes and Practice Pattern Study

10.21203/rs.3.rs-31249/v1 ◽

2020 ◽

Author(s):

Qingyu Niu ◽

Xinju Zhao ◽

Liangying Gan ◽

Xinling Liang ◽

Zhaohui Ni ◽

...

Keyword(s):

Physical Function ◽

Clinical Outcomes ◽

Cox Regression ◽

Demographic Data ◽

Simple Method ◽

Daily Dialysis ◽

Dialysis Vintage ◽

All Cause Mortality ◽

Dialysis Outcomes ◽

Climbing Stairs

Abstract Background: Hemodialysis (HD) patients usually have impaired physical function compared with general population. Self-reported physical function is a simple method to implement in daily dialysis care. This study aimed to examine the association of self-reported physical function with clinical outcomes of HD patients.Methods: Dialysis Outcomes and Practice Patterns Study (DOPPS) is a prospective cohort study. Data on 1427 HD patients in China DOPPS5 were analyzed. Self-reported physical function was characterized by 2 items of ‘moderate activities limited level’ and ’climbing stairs limited level’. Demographic data, comorbidities, hospitalization and death records were collected from patients’ records. Associations between physical function and outcomes were analyzed using COX regression models. The generalized linear mixed models were used to examine correlates of physical function limited level.Results: Compared to ‘limited a lot’ in moderate activities, ‘limited a little’ and ‘not limited at all’ groups were associated with lower all-cause mortality after adjusted for covariates (HR: 0.652, 95% CI: 0.435-0.977 and HR: 0.472, 95% CI: 0.241-0.927, respectively). And not limited in moderate activities was associated with lower risk of hospitalization compared with ‘limited a lot’ group after adjusted for covariates (HR: 0.747, 95% CI: 0.570-0.978). Meanwhile, compared to ‘limited a lot’ in climbing stairs, ‘limited a little’ and ‘not limited at all’ groups were associated with lower all-cause mortality (HR: 0.574, 95% CI: 0.380-0.865 and HR: 0.472, 95% CI: 0.293-0.762, respectively) but not hospitalization after fully adjusted. Factors including old age, female gender, longer dialysis vintage, catheter use, low serum albumin and combining with diabetes, coronary artery disease and cerebrovascular disease were related to higher limited levels of physical function (P < 0.05).Conclusion: Higher limited levels in self-reported physical function were associated with higher risk of all-cause mortality and hospitalization in HD patients.

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Haemodynamic assessment of right ventricular overload in pulmonary hypertension: old parameters still fit better than new ones

European Heart Journal ◽

10.1093/ehjci/ehaa946.2302 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Pereira ◽

J.G Santos ◽

M.J Loureiro ◽

F Ferreira ◽

A.R Almeida ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Logistic Regression ◽

Adverse Events ◽

Predictive Value ◽

Roc Curves ◽

Multivariate Logistic Regression ◽

Discrimination Power ◽

Haemodynamic Parameters ◽

All Cause Mortality ◽

Pulmonary Arterial

Abstract Introduction Right ventricular (RV) adaptation to the increased pulmonary load is a key determinant of outcomes in pulmonary hypertension (PH). Pulmonary vascular resistance (PVR) is widely recognized as haemodynamic measure of RV overload. Cardiac filling pressure (CFP), RV stroke work (RVSW), pulmonary artery (PA) compliance and PA pulsatility index (PAPi) are emerging as new haemodynamic parameters to assess RV function. Aims To assess the predictive value of CFP, RVSW, PA compliance and PAPi in PH and to compare it with standard haemodynamic parameters. Methods Retrospective study including all consecutive right heart catheterizations performed from April/2009 to October/2019 in a PH referral centre. Procedures presenting PH were selected [mean pulmonary arterial pressure (mPAP) >20 mmHg, according to the new definition of the 6st World Symposium on PH]. CFP was calculated as [right atrial pressure (RAP) − pulmonary capillary wedge pressure], value >0.63 associated with RV failure; RVSW as CO / [(heart rate × (mPAP-RAP) × 0.0136], value <15; PA compliance [SV / pulmonary arterial systolic pressure (PASP) − pulmonary arterial diastolic pressure (PADP)], value <2.5]; PAPi [(PSAP − PDAP) / RAP, value <1.85]. Multivariate logistic regression was used to identify predictors of all-cause mortality. Receiver operating characteristic (ROC) curves and area under curve (AUC) were used to assess discrimination power. Results From a total of 569 procedures, 470 fulfilled PH criteria: mean age 57.9±16.0 years, 67.7% female, 35.5% performed under pulmonary vasodilator therapy. Pre-capillary PH was diagnosed in 71.9% of cases. Chronic thromboembolic PH was the most common subtype (34.4%). Concerning standard haemodynamic parameters: mPAP was 39.0±12.0 mmHg, mean RAP 8.0±5.0 mmHg, mean RVP 7.5±5.0 uWood and CI 2.5±0.8 L/min/m2. Median value of CFP was 0.6 (IQR 0.4–0.8), RVSW 15.2 (IQR 9.7–25.0), PA compliance 2.1 (IQR 0.9–2.9) and PAPi 5.3 (IQR 3.2–8.5). All-cause mortality rate was 22.8%. Patients experiencing adverse events had lower values of cardiac index (2.3±0.6 vs 2.6±0.8 L/min/m2, p<0.01), RVSW (11.2 vs 16.7, p<0.01) and PA compliance (2.2 vs 2.9, p<0.01) and higher values of PVR (10.0±5.5 versus 6.8±4.6 uWood, p<0.01) and mean RAP (9.9±6.1 versus 7.4±4.5, p<0.01). Multivariate logistic regression identified 2 independent predictors of adverse events: mean RAP (OR 1.08, 95% CI 1.02–1.13, p<0.01) and PVR (OR 1.11, 95% CI 1.06–1.17, p<0.01). According to the ROC curves, new haemodynamic parameters did not have acceptable discrimination power to adverse events occurrence (figure). Conclusions In this study, new haemodynamic parameters to assess RV overload in PH were not independent predictors of adverse events as opposite to standard haemodynamic parameters. Further studies are needed to clarify their predictive value, as it has major implications for understanding the arterial load in diseases of the pulmonary circulation. Funding Acknowledgement Type of funding source: None

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Abstract P258: The Use Of Ace Inhibitors And Angiotensin Receptor Blockers Is Associated With Decreased Mortality And Increased Hospitalization Rate In Covid-19 Patients

Hypertension ◽

10.1161/hyp.78.suppl_1.p258 ◽

2021 ◽

Vol 78 (Suppl_1) ◽

Author(s):

Aaron Douen ◽

Jeremy Oh ◽

Wesley Romney ◽

Ryan Panetti ◽

Prakash Ramdass ◽

...

Keyword(s):

Logistic Regression ◽

Angiotensin Receptor Blockers ◽

Hospitalization Rate ◽

Host Cells ◽

Channel Blockers ◽

Multivariate Logistic Regression ◽

Converting Enzyme Inhibitors ◽

All Cause Mortality ◽

Receptor Blockers ◽

Secondary Outcomes

Introduction: Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are well known for upregulating ACE2 receptors. SARS-Cov-2 (COVID-19) infection utilizes the ACE2 receptor for proliferation and infection of host cells. Hypothesis: We hypothesize that the use of ACEI/ARBs will lead to a higher mortality and hospitalization rate among COVID-19 infected patients. Methods: The electronic health database at a public hospital in New York City was queried retrospectively for patients 18 years and older with a positive test for COVID-19 between 3/1/2020 - 4/1/2021. We examined baseline characteristics including comorbidities and whether they were prescribed ACEI/ARBs versus other medications including beta-blockers, calcium channel blockers, thiazides, or hydralazine. We categorized patients based on ACEI/ARB. The primary outcomes were all-cause mortality and hospitalization. The secondary outcomes were acute kidney injury, ventricular arrhythmia, myocardial infarction, heart failure, and intubation. We adjusted for comorbidities using multivariate logistic regression. Results: We identified 23,068 patients positive for SARS-CoV-2; 1,385 on ACEI/ARBs and 21,683 not on ACE/ARBs. The mean age in years was 65.90 +- 14.35 (SEM 0.386) and 44.01+-16.76, (SEM 0.114) for ACEI/ARB and non-ACEI/ARB respectively (p<0.001). The incidence of all cause mortality and hospitalization rate were significantly greater in the ACEI/ARB group. However, when adjusted for comorbidities using multivariate logistic regression, OR for mortality was 0.41 (CI 0.32-0.52, p<0.001) and for hospitalization was 4.12 (CI 3.49-4.86 p<0.001). For the secondary outcomes, non-ACEI/ARB patients had significantly increased unadjusted odds of all outcomes (p<0.001), except for ventricular tachycardia (p<0.618) and intubation (p< 0.214). Conclusion: Patients in the ACEI/ARB group demonstrated significantly lower mortality and increased hospitalization rates. Increased hospitalization may be due to more comorbidities. These results highlight the importance of continuing the use of ACEI and ARBs in COVID-19 patients for treatment of comorbidities and cardioprotective effects.

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Impact factors of multiple organ dysfunction syndromes complicating acute myocardial infarction in the elderly: multivariate logistic regression analysis

Critical Care ◽

10.1186/cc6465 ◽

2008 ◽

Vol 12 (Suppl 2) ◽

pp. P244 ◽

Cited By ~ 1

Author(s):

Y Zhao ◽

X Li ◽

Q Xue ◽

W Gao ◽

S Wang

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Logistic Regression ◽

Regression Analysis ◽

Multivariate Logistic Regression Analysis ◽

The Elderly ◽

Multiple Organ ◽

Impact Factors ◽

Multiple Organ Dysfunction ◽

Multivariate Logistic Regression

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Circulating miR-30d Predicts Survival in Patients with Acute Heart Failure

Cellular Physiology and Biochemistry ◽

10.1159/000459899 ◽

2017 ◽

Vol 41 (3) ◽

pp. 865-874 ◽

Cited By ~ 22

Author(s):

Junjie Xiao ◽

Rongrong Gao ◽

Yihua Bei ◽

Qiulian Zhou ◽

Yanli Zhou ◽

...

Keyword(s):

Heart Failure ◽

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

Multivariate Logistic Regression Analysis ◽

Multivariate Logistic Regression ◽

Univariate Logistic Regression Analysis ◽

Kaplan Meier ◽

All Cause Mortality

Background/Aims: Identification of novel biomarkers to identify acute heart failure (AHF) patients at high risk of mortality is an area of unmet clinical need. Recently, we reported that the baseline level of circulating miR-30d was associated with left ventricular remodeling in response to cardiac resynchronization therapy in advanced chronic heart failure patients. However, the role of circulating miR-30d as a prognostic marker of survival in patients with AHF has not been explored. Methods: Patients clinically diagnosed with AHF were enrolled and followed up for 1 year. Quantitative reverse transcription polymerase chain reactions were used to determine serum miR-30d levels. The univariate logistic regression analysis and multivariate logistic regression analysis were used to determine the predictors for all-cause mortality in AHF patients. Kaplan–Meier survival analysis was used to analyze the role of miR-30d in prediction of survival. Results: A total of 96 AHF patients were enrolled and followed up for 1 year. Serum miR-30d was significantly lower in AHF patients who expired in the one year follow-up period compared to those who survived. Univariate logistic regression analysis yielded 18 variables that were associated with all-cause mortality in AHF patients, while the multivariate logistic regression analysis identified 4 variables including heart rate, hemoglobin, serum sodium, and serum miR-30d level associated with mortality. ROC curve analysis showed that hemoglobin, heart rate and serum sodium displayed poor prognostic value for AHF (AUCs not higher than 0.700) compared to miR-30d level (AUC = 0.806). Kaplan–Meier survival analysis confirmed that patients with higher serum miR-30d levels had significantly lower mortality (P=0.001). Conclusion: In conclusion, this study shows evidence for the predictive value of circulating miR-30d as 1-year all-cause mortality in AHF patients. Large multicentre studies are further needed to validate our findings and accelerate the transition to clinical utilization.

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Abstract WMP3: Predictors And Outcomes Associated With Rescue Therapy In SWIFT

Stroke ◽

10.1161/str.44.suppl_1.awmp3 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Marc A Lazzaro ◽

Osama O Zaidat ◽

Jeffrey Saver

Keyword(s):

Logistic Regression ◽

Multivariate Analysis ◽

Endovascular Therapy ◽

Rescue Therapy ◽

Demographic Data ◽

Lower Percentage ◽

Regression Analyses ◽

Multivariate Logistic Regression ◽

Vessel Patency ◽

Iv Tpa

Introduction: In the Solitaire With the Intention For Thrombectomy (SWIFT) trial, rescue therapy was used when the Solitaire or Merci device was unable to restore vessel patency. Markers for non-recanalization in acute stroke have been reported for IV tPA, however similar predictors are not known for endovascular therapy. We sought to identify predictors and outcomes associated with rescue therapy in the SWIFT trial. Methods: Rescue therapy was defined per SWIFT study protocol, and included the use of an alternative device, agent, or maneuver following failure to recanalize with 3 retrieval attempts using the initial device. Clinical, angiographic, and demographic data was reviewed. Statistical analysis was performed using t-test or Wilcoxon methods and multivariate logistic regression analyses. Results: Among a total of 144 patients enrolled (31 roll-in phase Solitaire patients, and 113 randomized patients, 58 Solitaire, 55 Merci), 43 (29.9%) required rescue therapy. Baseline demographics for patients with and without rescue therapy were no different. Rescue therapy was used in a higher percentage of patients randomized to Merci than Solitaire (43% vs 21%, p = 0.009). Patients with rescue therapy experienced longer time to recanalization (p < 0.001), a lower percentage of successful recanalization (p < 0.001), and a lower percentage of good outcome (p = 0.009). In multivariate analysis, predictors of rescue therapy were those patients randomized to the Merci group (OR 3.99, 95% CI 1.58, 10.10) and patients over age 80 years (OR 3.51, 95% CI 1.06, 11.64). Non-significant trends toward an increased need for rescue therapy were observed in patients with hypertension (p = 0.09), and occlusions of the carotid terminus and M1 MCA compared with other locations (p = 0.10). No association was observed with rescue therapy and afib (p = 0.47) or IV tPA failure (p = 0.49), and rescue therapy was not associated with symptomatic ICH (p = 0.43). Conclusions: Predictors of rescue therapy included Merci treatment group and age, while trend toward an increased need of rescue therapy was observed with hypertension and proximal clot location. Rescue therapy was associated with fewer good outcomes. These findings may reflect targets for improvement in endovascular therapy.

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Natural Course of Cerebral Cavernous Malformations in Children: A Five-Year Follow-Up Study

Stroke ◽

10.1161/strokeaha.121.035338 ◽

2021 ◽

Author(s):

Alejandro N. Santos ◽

Laurèl Rauschenbach ◽

Dino Saban ◽

Bixia Chen ◽

Annika Herten ◽

...

Keyword(s):

Logistic Regression ◽

Brain Stem ◽

Odds Ratio ◽

Pediatric Patients ◽

Cox Regression ◽

Cerebral Cavernous Malformations ◽

Multivariate Logistic Regression ◽

Cavernous Malformations ◽

History Of

Background and Purpose: The purpose of this study was to investigate the natural course of cerebral cavernous malformations (CCM) in the pediatric population, with special emphasis on the risk of first and recurrent bleeding over a 5-year period. Methods: Our institutional database was screened for patients with CCM treated between 2003 and 2020. Patients ≤18 years of age with complete magnetic resonance imaging data set, clinical baseline characteristics, and ≥1 follow-up examination were included. Surgically treated individuals were censored after CCM removal. We assessed the impact of various parameters on first or recurrent intracerebral hemorrhage (ICH) at diagnosis using univariate and multivariate logistic regression adjusted for age and sex. Kaplan-Meier and Cox regression analyses were performed to determine the cumulative 5-year risk for (re)hemorrhage. Results: One hundred twenty-nine pediatric patients with CCM were analyzed. Univariate logistic regression identified brain stem CCM (odds ratio, 3.15 [95% CI, 1.15−8.63], P =0.026) and familial history of CCM (odds ratio, 2.47 [95% CI, 1.04−5.86], P= 0.041) as statistically significant predictors of ICH at diagnosis. Multivariate logistic regression confirmed this correlation (odds ratio, 3.62 [95% CI, 1.18−8.99], P= 0.022 and odds ratio, 2.53 [95% CI, 1.07−5.98], P =0.035, respectively). Cox regression analysis identified ICH as mode of presentation (hazard ratio, 14.01 [95% CI, 1.80−110.39], P= 0.012) as an independent predictor for rehemorrhage during the 5-year follow-up. The cumulative 5-year risk of (re)bleeding was 15.9% (95% CI, 10.2%−23.6%) for the entire cohort, 30.2% (20.2%−42.3%) for pediatric patients with ICH at diagnosis, and 29.5% (95% CI, 13.9%−51.1%) for children with brain stem CCM. Conclusions: Pediatric patients with brain stem CCM and familial history of CCM have a higher risk of ICH as mode of presentation. During untreated 5-year follow-up, they revealed a similar risk of (re)hemorrhage compared to adult patients. The probability of (re)bleeding increases over time, especially in cases with ICH at presentation or brain stem localization.

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Serum Irisin Predicts Mortality Risk in Acute Heart Failure Patients

Cellular Physiology and Biochemistry ◽

10.1159/000477867 ◽

2017 ◽

Vol 42 (2) ◽

pp. 615-622 ◽

Cited By ~ 12

Author(s):

Shutong Shen ◽

Rongrong Gao ◽

Yihua Bei ◽

Jin Li ◽

Haifeng Zhang ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

Multivariate Logistic Regression Analysis ◽

Curve Analysis ◽

Multivariate Logistic Regression ◽

Roc Curve Analysis ◽

Kaplan Meier ◽

All Cause Mortality

Background/Aims: Irisin is a peptide hormone cleaved from a plasma membrane protein fibronectin type III domain containing protein 5 (FNDC5). Emerging studies have indicated association between serum irisin and many major chronic diseases including cardiovascular diseases. However, the role of serum irisin as a predictor for mortality risk in acute heart failure (AHF) patients is not clear. Methods: AHF patients were enrolled and serum was collected at the admission and all patients were followed up for 1 year. Enzyme-linked immunosorbent assay was used to measure serum irisin levels. To explore predictors for AHF mortality, the univariate and multivariate logistic regression analysis, and receiver-operator characteristic (ROC) curve analysis were used. To determine the role of serum irisin levels in predicting survival, Kaplan-Meier survival analysis was used. Results: In this study, 161 AHF patients were enrolled and serum irisin level was found to be significantly higher in patients deceased in 1-year follow-up. The univariate logistic regression analysis identified 18 variables associated with all-cause mortality in AHF patients, while the multivariate logistic regression analysis identified 2 variables namely blood urea nitrogen and serum irisin. ROC curve analysis indicated that blood urea nitrogen and the most commonly used biomarker, NT-pro-BNP, displayed poor prognostic value for AHF (AUCs ≤ 0.700) compared to serum irisin (AUC = 0.753). Kaplan-Meier survival analysis demonstrated that AHF patients with higher serum irisin had significantly higher mortality (P<0.001). Conclusion: Collectively, our study identified serum irisin as a predictive biomarker for 1-year all-cause mortality in AHF patients though large multicenter studies are highly needed.

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CMET-39. DISPARITIES IN STEREOTACTIC RADIOSURGERY USE AND OUTCOMES FOR MELANOMA BRAIN METASTASES – AN AUSTRALIAN POPULATION-BASED STUDY

Neuro-Oncology ◽

10.1093/neuonc/noz175.240 ◽

2019 ◽

Vol 21 (Supplement_6) ◽

pp. vi60-vi60

Author(s):

Wee Loon Ong ◽

Morikatsu Wada ◽

Farshad Foroudi

Keyword(s):

Logistic Regression ◽

Brain Metastases ◽

Stereotactic Radiosurgery ◽

Cox Regression ◽

Population Based ◽

Mortality Data ◽

Multivariate Logistic Regression ◽

Factors Associated ◽

Significant Difference ◽

Melanoma Brain Metastases

Abstract INTRODUCTION We aim to evaluate the use of stereotactic radiosurgery (SRS) among patients who received radiotherapy for melanoma brain metastases (MBM), and the associated outcomes. METHODS This is a population-based cohort of patients who received radiotherapy for MBM between 2013 and 2016, as captured in the Victorian Radiotherapy Minimum Dataset. Brain radiotherapy was classified as SRS (including multi-fraction stereotactic radiotherapy) and non-SRS. Mortality data was obtained through linkage with the Victorian Cancer Registry. The primary outcomes were: proportion of patients who had SRS for MBM, and overall survival (OS) following radiotherapy. Multivariate logistic regression was used to evaluate factors associated with SRS use, Kaplan Meier method for estimation of OS, and multivariate Cox regression for evaluation of factors associated with OS. RESULTS 294 patients received 551 courses of radiotherapy for MBM in this study, of which 39% (116/294) patients received SRS. Patients from higher socioeconomic status were more likely to have SRS – 49% in top quintile vs. 22% in lowest quintile (P< 0.009). Patients treated in regional centres were less likely to have SRS compared to metropolitan centres (3% vs. 48%,P< 0.001). In multivariate logistic regression, treatment in regional centres was the only factor independently associated with lower likelihood of receiving SRS (OR=0.04;95%CI=0.01–0.18;P< 0.001). The median follow-up of the cohort was 3.8 months (range: 0.1–42 months). There were 227 death observed, with 12-month OS of 23%. There was significant difference in 12-month OS between patients who received SRS compared to those who did not receive SRS (43% vs. 11%; P< 0.001). In multivariate Cox regression, the use of SRS was the only factor independently associated with OS (HR=0.38;95%CI=0.28–0.51;P< 0.001). CONCLUSION We observed sociodemographic and institutional disparities in SRS use for MBM. The observed impact of SRS use on OS is most likely confounded by patient selections for SRS.

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