scholarly journals Lipid and lipoprotein predictors of functional outcomes and long-term mortality after surgical sepsis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Faheem W. Guirgis ◽  
Christiaan Leeuwenburgh ◽  
Lyle Moldawer ◽  
Gabriela Ghita ◽  
Lauren Page Black ◽  
...  
Keyword(s):  
Cox Regression ◽  
Performance Status ◽  
Density Lipoprotein ◽  
Poor Performance ◽  
Lipid Biomarkers ◽  
Surgical Intensive Care Unit ◽  
Poor Performance Status ◽  
Surgical Intensive Care ◽  
Long Term Mortality

Abstract Rationale Sepsis is a life-threatening, dysregulated response to infection. Lipid biomarkers including cholesterol are dynamically regulated during sepsis and predict short-term outcomes. In this study, we investigated the predictive ability of lipid biomarkers for physical function and long-term mortality after sepsis. Methods Prospective cohort study of sepsis patients admitted to a surgical intensive-care unit (ICU) within 24 h of sepsis bundle initiation. Samples were obtained at enrollment for lipid biomarkers. Multivariate regression models determined independent risk factors predictive of poor performance status (Zubrod score of 3/4/5) or survival at 1-year follow-up. Measurements and main results The study included 104 patients with surgical sepsis. Enrollment total cholesterol and high-density lipoprotein (HDL-C) levels were lower, and myeloperoxidase (MPO) levels were higher for patients with poor performance status at 1 year. A similar trend was seen in comparisons based on 1-year mortality, with HDL-C and ApoA-I levels being lower and MPO levels being higher in non-survivors. However, multivariable logistic regression only identified baseline Zubrod and initial SOFA score as significant independent predictors of poor performance status at 1 year. Multivariable Cox regression modeling for 1-year survival identified high Charlson comorbidity score, low ApoA-I levels, and longer vasopressor duration as predictors of mortality over 1-year post-sepsis. Conclusions In this surgical sepsis study, lipoproteins were not found to predict poor performance status at 1 year. ApoA-I levels, Charlson comorbidity scores, and duration of vasopressor use predicted 1 year survival. These data implicate cholesterol and lipoproteins as contributors to the underlying pathobiology of sepsis.

Aspartate transaminase/alanine transaminase ratio as a significant prognostic factor in patients with sepsis: a retrospective analysis

2020 ◽  
Author(s):  
Pengyue Zhao ◽  
Renqi Yao ◽  
Chao Ren ◽  
Songyan Li ◽  
Yuxuan Li ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Cox Regression ◽  
Alanine Transaminase ◽  
Receiver Operating Curve ◽  
Surgical Intensive Care Unit ◽  
Significant Prognostic Factor ◽  
Aspartate Transaminase ◽  
Surgical Intensive Care ◽  
Long Term Mortality

Abstract Background: The study was performed to investigate the relationship between aspartate transaminase/alanine transaminase ratio (DRR) and long-term mortality among patients diagnosed with sepsis or septic shock. Methods: We conducted a retrospective study among adult septic patients who were admitted to surgical intensive care unit (ICU) of the Chinese People's Liberation Army (PLA) General Hospital from January 2014 to December 2018. Baseline characteristics were compared between survivors and non-survivors. We applied univariate as well as multivariate Cox regression analyses to evaluate DRR in relation to 180-day mortality. The potential prognostic value of DRR in predicting mortality rate was assessed by receiver operating curve (ROC) analysis. Besides, we conducted subgroup analysis by stratifying patients via optimal DRR cut-off value. Results: We included a total number of 183 patients in the current study, 44 (24%) patients died within 180-day hospitalization. Univariate and multivariate Cox analysis revealed that DRR was an independent predictor of 180-day mortality (hazard ratio [HR] 1.421, 95% confidence interval [CI] 1.073-1.883, P = 0.014). The predicting accuracy of 180-day mortality for DRR was presented as ROC with an area under the curve (AUC) of 0.708 (95% CI 0.629–0.786, P < 0.001). As we stratified all enrolled patients into two groups by using the optimal cut-off value of 1.29, we observed a significantly higher mortality in patients with relatively high DRR. Conclusions: An elevated DRR was associated with higher 180-day mortality among septic patients, and DRR might be an optimal marker for predicting the long-term mortality of sepsis. More prospective and randomized trials are needed to confirm the prognostic value of DRR.

HIV-Associated Burkitt Lymphoma: Case Report and Literature Review

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5072-5072 ◽  
Author(s):  
Daniel Hartman Johnson ◽  
Thomas M. Reske ◽  
Herbert Twase ◽  
Marco Ruiz ◽  
Rachna Jetly-Shridhar
Keyword(s):  
Burkitt Lymphoma ◽  
Advanced Disease ◽  
Performance Status ◽  
Poor Performance ◽  
Incidence Rates ◽  
Cd4 Count ◽  
Poor Performance Status ◽  
Hiv Patients ◽  
Southern Louisiana

Abstract Introduction HIV associated Burkitt lymphoma (BL) is a highly aggressive lymphoma. Compared to other AIDS related non-Hodgkin lymphoma’s its clinical presentation is less predictable and characterized by rapid clinical changes. The paradigm shift to treat HIV associated disease with highly effective intensive chemotherapy regimens while managing immunosuppression has made it possible to achieve remission and long-term survival. Southern Louisiana has one the of the highest incidence rates of HIV and cancers in the US. The authors present a challenging case of a 33-year old HIV+ male from southern Louisiana with advanced stage BL. The patient presented with advanced disease and a poor performance status. His initial providers recommended palliation only and significant education was needed to allow aggressive treatment. The patient tolerated induction chemotherapy and remains in remission. This is a case based review of local and nationwide epidemiology and the trial data supporting different treatment options for HIV associated Burkitt lymphoma. Case Our patient is a 33 year-old male who presented with severe cachexia, poor performance status and clinical symptomatic cord compression. He was diagnosed with advanced stage Burkitt lymphoma including bone marrow involvement. His CD4 count was 277 with an HIV viral load of 571,000 copies/mL. Although he had a poor performance status and his primary team favored palliation only he underwent induction chemotherapy with 4 cycles of infusional dose adjusted R-EPOCH with IT CNS chemoprophylaxis. HAART therapy with efavirenz/emtricitabine/tenofovir was started during his initial admission. He tolerated this regimen well, clinically dramatically improved being independent in his ADL/IADLs, and remains in remission. Discussion The pathogenesis of HIV-associated Burkitt lymphoma is linked to oncogenic virus co-infection (40% EBV association) and chronic HIV antigen stimulation that provoke expansion of polyclonal B-cells. This leads to oncogenic chromosomal translocations - most notably t(8;14) causing constitutive expression of oncogene c-Myc. HIV patients have a 60 to 200-fold increased incidence of NHL. Relative risk for BL in HIV patients is 261-fold higher compared to the general population. Unlike the nationwide reported 19 per 100,000 person-years, data from a large HIV clinic in southern Louisiana continues to show an incidence rate of 23 per 100,000 person-years. Louisiana continues to have comparatively high incidence rates in HIV (4th in US) and cancer (11th in US) with the highest rates in southern Louisiana parishes. It is important for community physicians, especially in these areas, to feel more confident when treating these HIV associated malignancies. Historically highly immunosuppressive chemotherapy has been avoided in HIV patients with lymphoma as studies in the 1990’s showed increased toxicity. The addition of the monoclonal C20 antibody rituximabin the treatment of AIDS associated NHLs was also controversial, as trial results showed increase infectious death rates. However, these clinical trials confirmed similar death rates from infections in individuals with a CD4 count >50. In addition concomitant use of HAART with chemotherapy has improved overall survival. Although the more dose intense Burkitt regimens have not been studied extensively in HIV-associated BL, CODOX-M/IVAC and DA-EPOCH +/- Rituximab (depending on CD4 count) have shown good efficacy and tolerance and are treatment regimens of choice this disease. A recent trial with 14 patients with HIV associated BL receiving RD-CODOXM/IVAC had 86% progression free survival rate at 1 year; patients receiving concomitant HAART had 100% PFS rate at 1 year. In another trial, 10 HIV associated BL patients receiving DA-EPOCH-R showed a 100% overall survival rate at 57 months. Conclusion HIV associated Burkitt lymphoma should be treated with HAART and high dose chemotherapy. Long-term remission has been shown with regimens including CODOX-M/IVAC and DA-EPOCH +/-Rituximab (R use discouraged in low CD4 counts). This case based report outlines the relatively high prevalence of disease in Southern Louisiana and emphasizes that remission is possible in patients with poor performance status and advanced disease. Disclosures: No relevant conflicts of interest to declare.

Should all patients (pts) with advanced biliary cancers receive first-line treatment with cisplatin and gemcitabine (GC)?

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 244-244
Author(s):  
Vanessa Costa Miranda ◽  
Luiza Dib-Faria ◽  
Maria Ignez Freitas Melro Braghiroli ◽  
Jorge Sabbaga ◽  
Daniel Fernandes Saragiotto ◽  
...  
Keyword(s):  
Median Survival ◽  
Cox Regression ◽  
Performance Status ◽  
Multivariable Analysis ◽  
Poor Performance ◽  
Median Number ◽  
Poor Performance Status ◽  
Poor Survival ◽  
First Line ◽  
Dismal Prognosis

244 Background: GC is considered the standard of care for pts with advanced biliary tract cancer (BTC), providing median survival of nearly one year. (Valle J et al. NEJM 2010) Nevertheless, many pts experience poor outcomes, leading to a growing interest to identify pts who might benefit from such treatment. Here we aimed to investigate clinical and laboratory factors associated with poor survival among BTC pts treated with GC. Methods: We retrospectively evaluated all consecutive pts with advanced/metastatic BTC who received first line GC at the Instituto do Cancer do Estado de Sao Paulo, Brazil, in a 2 year-period. Clinical and laboratory variables that could influence pts’ outcomes were gathered from medical charts. Cox regression proportional hazard model was used to investigate the following prognostic factors for death: pre-treatment biliary deobstruction, baseline Ca 19.9, any GC interruptions or dose reductions, baseline ECOG status, Charlson Comorbidity Index (CCI) and age. P values < 0.05 in multivariable analysis were considered significant. Results: From January/2009 to July/2011, 72 pts were identified. The median age was 60 years (range 30-80 years), 45 pts (62.5%) were female and 50 (69.4%) presented baseline ECOG 0-1. The median number of cycles of CG was 4 (range 1-9). Grade 3 /4 neutropenia and thrombocytopenia occurred in 16.6% and 12.5% of pts, respectively. Median survival of the whole cohort was 9.53 months (95% CI: 6.2 - 11.4). Median survival in pts with ECOG 0/1 was 13.5 months (95% CI: 9,5 – NR) and among pts with ECOG 2/3 3,5 months (95% CI: 1-7). In the Cox multivariable model, ECOG 2 /3 versus 0/1 (HR: 8.4, 95% CI: 3.4 to 20.7; p<0.001) and CCI score ≥ 2 (HR: 9.5 95% CI: 1.6 to 55.3; p= 0.012) significantly predicted for poor survival. There was a trend for improved survival among pts who had biliary drainage before starting GC (HR: 2.3 95% CI: 1.0 - 5.3; p= 0.051). Conclusions: In this retrospective cohort of unselected pts with advanced BTC treated with first line GC, poor performance status and multiple comorbid illnesses were associated with dismal prognosis. Treatment with GC should be carefully discussed before being offered to these pts.

scholarly journals Evaluation of the prognostic benefit of identifying the probable primary site in cancer of unknown primary

2015 ◽  
Vol 6 (3) ◽  
pp. 22-28
Author(s):  
Joyutpal Das ◽  
Shahid Gilani
Keyword(s):  
Median Survival ◽  
Cox Regression ◽  
Performance Status ◽  
Disease Onset ◽  
Significant Proportion ◽  
Poor Performance ◽  
Primary Site ◽  
University Hospital ◽  
Unknown Primary ◽  
Poor Performance Status

Abstract With the development of site-specific cancer therapy, identifying the primary origin allows the oncologist to personalise therapy for patients with the cancer of unknown primaries (CUPs). At present, immunohistochemistry (IHC) screening is the standard method used to postulate the primary site in CUP. In this retrospective study, we evaluated the prognostic benefit of identifying the primary site in CUP. All 84 patients who presented with suspected CUP to the Royal Stoke University Hospital between 2011 and 2012 were included in our study. Forty-eight percent (40/84) of these patients were unable to undergo necessary investigations to identify primary sites because of poor performance status. IHC screening was able to postulate the primary site in 59% (26/44) of the remaining patients with confirmed CUP. Therefore, the primary site was not identified in a significant proportion of patients with CUP. The median survival of confirmed CUP with probable primary site was 2.0 months (95% confidence interval (CI): 1.2 to 2.9 months), whereas the median survival of confirmed CUP with no probable primary site was 4.1 months (95% CI: 1.5 to 9.7 months). This difference in survival time was statistically significant. In addition, using the Cox regression model, we found that patients with confirmed CUP with primary sites had prognostically unfavourable diseases with a shorter median survival, regardless of the age of disease onset, gender, sites of metastases or number of metastases. One approach to improve the survival would be to start systemic therapy at the earliest possible opportunity rather than waiting for all investigation results, such as IHC.

Attendance at National Cancer Institute Cancer Centers (NCI-CC) by older adults with myeloma.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18020-e18020
Author(s):  
Tanya Marya Wildes ◽  
Mark A Fiala
Keyword(s):  
Older Adults ◽  
Cox Regression ◽  
Performance Status ◽  
Tertiary Care ◽  
Community Setting ◽  
Poor Performance ◽  
Lower Mortality ◽  
Mortality Data ◽  
Poor Performance Status ◽  
Nationally Representative

e18020 Background: Older adults with myeloma (MM) have poorer survival than younger patients. NCI-CC attendance is associated with superior outcomes in many cancers. Studies show that older adults are reluctant to be treated in university settings and are more likely to be treated in the community setting. We aimed to define the factors associated with NCI-CC attendance in older adults with mm from a nationally representative sample and its association with survival. Methods: We identified all mm cases in the SEER-Medicare linked database from 2000-2011. Included cases were enrolled in Medicare Part A and B > 1 year prior to diagnosis; we excluded those enrolled at age < 65. Any center designated a NCI-clinical or -comprehensive center in 2002, 2005, or 2010 was considered an NCI-CC; attendance was defined as ≥2 separate claims from an NCI-CC in the 1-year after mm diagnosis. CM were calculated using the Charlson Comorbidity (CM) Index (CCI). Poor performance status indicators (PSi) were coded as present or absent. Logistic regression was performed to determine if age was associated with NCI-CC attendance. Cox regression was determined the association of NCI-CC attendance with survival. Results: 21,843 cases were included; median age was 77 years. Overall 10.6% of the cohort attended an NCI-CC. Increasing age was associated with decreasing NCI-CC attendance rates: 18.6% (age 65-69), 13.9% (age 70-74), 9.0% (age 75-79) and 6.0% (age ≥80). After controlling for race, gender, socioeconomic status, and urban/rural regions, increasing age, poor PSi and CCI were each associated with lower odds of NCI-CC attendance [Age: OR 0.925/year (95% CI 0.92-0.93); Poor PSi: OR 0.87 (CI 0.76-1.00); CM: 0.94/CCI point (CI 0.90-0.97)]. After controlling for sociodemographics, PS and CCI, NCI-CC attendance was associated with lower mortality [HR 0.74 (95% CI 0.70-0.78)]. Conclusions: With increasing age, poor PS indicators and CM, pts are less likely to attend an NCI-CC. After controlling for other prognostic factors, attendance at an NCI-CC was associated with lower mortality. Data from trials in older mm pts from NCI-CC or other tertiary care centers must be viewed with caveat that pts tend to have better PS and fewer CM.

Chromosome 1 abnormalities and clinical outcomes in multiple myeloma in the era of novel agents.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 8044-8044
Author(s):  
Smith Giri ◽  
Scott F. Huntington ◽  
Rong Wang ◽  
Amer Methqal Zeidan ◽  
Nikolai Alexandrovich Podoltsev ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Real World ◽  
Cox Regression ◽  
Performance Status ◽  
Poor Performance ◽  
Total Sample ◽  
Chromosome 1 ◽  
Poor Performance Status ◽  
Cox Regression Analysis ◽  
Entire Cohort

8044 Background: Abnormalities of chromosome 1 (C1A) are common genetic mutations in patients (pts) with Multiple Myeloma (MM). While several small studies have reported worse outcomes for C1A, the prevalence, real-world treatment and outcomes for pts with C1A are unknown. Methods: We used the Flatiron Health Electronic Health Record (EHR)-derived database to identify pts with newly diagnosed MM from 01/2011 to 03/2018 with Fluorescence In situ Hybridization (FISH) testing within 90 days of diagnosis and defined lines of therapy. We identified pts with C1A and other high-risk mutations (HRM; 17p deletion, t14;16 and t4;14). Pts were followed until 3/31/2018 or death. The primary outcome was overall survival (OS). We used Kaplan Meier methods and compared OS for pts with/without C1A using log-rank tests stratified for HRM. We used Cox regression analysis to compare OS across groups, adjusting for age, gender, performance status, stage, HRM and treatment (triple regimen vs other). Results: The total sample included 3,578 pts: median age at diagnosis was 69 yrs (IQR 31-85), with 54% males and 60% whites. IgG(57%) and IgA(22%) were the most common M-protein subtypes. At baseline, 844 (24%) had C1A. Pts with C1A had higher stage (ISS III 35% vs 26%; p < 0.01) and other HRM (27% vs 14%, p < 0.01). Common first line-therapies included bortezomib(V), lenalidomide(R) and dexamethasone (D) (35%), RD (20%) followed by VD(15%). Use of VRD was higher with C1A vs without (40% vs 33% respectively, p < 0.01). Median OS was 66.9 months for the entire cohort and was lower for pts with C1A vs without (median OS 46.6 vs 70.1 months; log rank p < 0.01). Multivariable Cox survival analysis showed that C1A was independently associated with worse OS (adjusted HR 1.64; 95% CI 1.23-2.19); p < 0.01). Other predictors of worse survival included older age, black ethnicity, higher ISS stage, poor performance status and HRM. Conclusions: In this large study of real-world practice, C1A was associated with inferior OS independent of other HRM, despite higher use of VRD. Future studies are needed to assess whether specific regimens improve outcomes for C1A compared to patients without HRM.

scholarly journals Hypernatremia at admission predicts poor survival in patients with terminal cancer: a retrospective cohort study

2020 ◽  
Author(s):  
Minseok Seo ◽  
In Cheol Hwang ◽  
Jaehun Jung ◽  
Hwanhee Lee ◽  
Jae Hee Choi ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cox Regression ◽  
Performance Status ◽  
Poor Performance ◽  
Electrolyte Imbalance ◽  
Poor Performance Status ◽  
Terminal Cancer ◽  
Care Providers ◽  
Cox Regression Analysis ◽  
Male Sex

Abstract Background Although palliative care providers, patients, and their familes rely heavily on accurate prognostication, the prognostic value of electrolyte imbalance has received little attention. Methods As a retrospective review, we screened inpatients with terminal cancer admitted between January 2017 and May 2019 to one hospice-palliative care unit. Clinical characteristics and laboratory results were obtained from medical records for multivariable Cox regression analysis of independant prognostic factors. Results Of the 487 patients who qualified, 15 (3%) were hypernatremic upon admission. Median survival time was 26 days. Parameters associated with shortened survival included male sex, advanced age (> 70 years), lung cancer, poor performance status, elevated inflammatory markers, azotemia, impaired liver function, and hypernatermia. In a multivariable Cox proportional hazards model, male sex (hazard ratio [HR]=1.53, 95% confidence interval [CI]: 1.15–2.04), poor performance status (HR=1.45, 95% CI: 1.09–1.94), leukocytosis (HR=1.98, 95% CI: 1.47–2.66), hypoalbuminemia (HR=2.06, 95% CI: 1.49–2.73) and hypernatremia (HR=1.55, 95% CI: 1.18–2.03) emerged as significant predictors of poor prognosis. Conclusion Hypernatremia may be a useful gauge of prognosis in patients with terminal cancer. Further corroborative studies of large scale and prospective design are needed.

scholarly journals Suggestions for Escaping The Dark Ages for Pediatric Diffuse Intrinsic Pontine Glioma Treated with Radiotherapy: Analysis of Prognostic Factors From The National Multicenter Study

2021 ◽  
Author(s):  
Hyun Ju Kim ◽  
Joo Ho Lee ◽  
Youngkyong Kim ◽  
Do Hoon Lim ◽  
Shin-Hyung Park ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Therapeutic Strategy ◽  
Performance Status ◽  
Poor Performance ◽  
Diffuse Intrinsic Pontine Glioma ◽  
Poor Performance Status ◽  
Pontine Glioma ◽  
Term Survival

Abstract Purpose This multicenter retrospective study aimed to investigate prognostic factors for survival, encompassing clinical and radiologic features and treatments, in newly diagnosed diffuse intrinsic pontine glioma (DIPG) patients treated with radiotherapy. Methods Patients <30 years of age who underwent radiotherapy as an initial treatment for DIPG between 2000 and 2018 were included; patients who did not undergo an MRI at diagnosis and those with pathologically diagnosed grade I glioma were excluded. We examined medical records of 162 patients collected from 10 participating centers in Korea. The patients’ clinical and radiological variables, molecular and histopathologic data, and treatment response were evaluated to identify the prognosticators for DIPG and estimate survival outcomes. Results The median follow-up period was 10.8 months (interquartile range, 7.5–18.1). The 1- and 2-year overall survival (OS) rates were 53.5% and 19.0%, respectively, with a median OS of 13.1 months. Long term survival rate (≥2 years) was 16.7%, and median OS was 43.6 months. Age (<10 years), poor performance status, treatment before 2010, and post-radiotherapy necrosis were independent prognostic factors related to poor OS in the multivariate analysis. In patients with increased post-radiotherapy necrosis, the median OS was 13.3 months for bevacizumab group and 11.4 months for no-bevacizumab group (P = 0.138). Conclusion Therapeutic strategy for DIPG has remained unchanged over time, and its prognosis remains poor. Our findings suggest that appropriate efforts are needed to reduce the occurrence of post-radiotherapy necrosis. Further well-designed clinical trials are recommended to improve the poor prognosis observed in DIPG patients.

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