scholarly journals Early hemoglobin status is predictive of outcomes and long-term mortality of sepsis

2020 ◽  
Author(s):  
Desheng Qi ◽  
Milin Peng
Keyword(s):  
Protective Factor ◽  
Proportional Hazards ◽  
Critical Role ◽  
Survival Rates ◽  
Cox Proportional Hazards ◽  
Hemoglobin Level ◽  
Survival Group ◽  
Significant Difference ◽  
One Year

Abstract Background: Hemoglobin change plays a critical role in progress of sepsis. However, the contribution of hemoglobin change to outcomes of patients with sepsis is still unknown. The aim of our study is to investigate the effect of early hemoglobin level within 48h after admission to Intensive Care Unit (ICU) on long term prognosis for sepsis. Methods: In this single centered, cohort study, we included patients from different ICU departments of Xiangya hospital from 2016 to 2018. Out of 1800 ICU patients, 199 patients with sepsis matched inclusion criteria. All 199 patients were divided into three groups according to 70, 80, and 90 g/L hemoglobin statuses, respectively. Results: Our study showed seventy-nine patients (39.7%) with ≤90g/L hemoglobin, forty-seven patients (23.6%) with hemoglobin ≤80g/L, and twenty-five (12.6%) with hemoglobin ≤70g/L at 48h after admission. Compared to survival group, there were higher rates of patients with hemoglobin ≤80g/L (33.7% vs. 15.1%, P=0.003), hemoglobin ≤70g/L (18.5% vs. 7.5%, P=0.031) in non-survival group, but similar rate of hemoglobin ≤90g/L patients (46.7% vs. 34.0%, P=0.081). Kaplan-Meier survival analysis showed that significant difference occurred among all three groups with total one-year survival rates. Furthermore, multivariate cox proportional hazards regression analysis showed that serum hemoglobin concentration ≤ 80g/L at 48h admission (Hazard Ratio HR 1.736, 95% CI 1.131-2.665, P=0.012), the occurrence of ARDS (HR 1.814, 95% CI 1.184-2.778, P=0.006), the use of CRRT (HR 1.569, 95% CI 1.030-2.390, P=0.036), and septic shock (HR 1.776, 95% CI 1.124-2.804, P=0.014) were independent risk predictors for one-year mortality in septic patients. Whereas the infection site from abdomen (HR 0.281, 95% CI 0.113-0.697, P=0.006) was the only independent protective factor for mortality in septic patients. Conclusion: ≤80 g/L hemoglobin within 48h after admission to ICU was the independent risk factor for mortality for patients with sepsis. Attention should be raised up to target early hemoglobin level in course of sepsis to achieve better outcomes of sepsis. Future larger researches and randomized controlled trials are needed to validate our results.

scholarly journals Survival rates and prognostic factors in right- and left-sided colon cancer stage I–IV: an unselected retrospective single-center trial

2021 ◽  
Author(s):  
Claudius E. Degro ◽  
Richard Strozynski ◽  
Florian N. Loch ◽  
Christian Schineis ◽  
Fiona Speichinger ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Overall Survival ◽  
Blood Level ◽  
Proportional Hazards ◽  
Survival Rates ◽  
Cox Proportional Hazards ◽  
Stage I ◽  
Cancer Stage ◽  
Single Center ◽  
Significant Difference

Abstract Purpose Colorectal cancer revealed over the last decades a remarkable shift with an increasing proportion of a right- compared to a left-sided tumor location. In the current study, we aimed to disclose clinicopathological differences between right- and left-sided colon cancer (rCC and lCC) with respect to mortality and outcome predictors. Methods In total, 417 patients with colon cancer stage I–IV were analyzed in the present retrospective single-center study. Survival rates were assessed using the Kaplan–Meier method and uni/multivariate analyses were performed with a Cox proportional hazards regression model. Results Our study showed no significant difference of the overall survival between rCC and lCC stage I–IV (p = 0.354). Multivariate analysis revealed in the rCC cohort the worst outcome for ASA (American Society of Anesthesiologists) score IV patients (hazard ratio [HR]: 16.0; CI 95%: 2.1–123.5), CEA (carcinoembryonic antigen) blood level > 100 µg/l (HR: 3.3; CI 95%: 1.2–9.0), increased lymph node ratio of 0.6–1.0 (HR: 5.3; CI 95%: 1.7–16.1), and grade 4 tumors (G4) (HR: 120.6; CI 95%: 6.7–2179.6) whereas in the lCC population, ASA score IV (HR: 8.9; CI 95%: 0.9–91.9), CEA blood level 20.1–100 µg/l (HR: 5.4; CI 95%: 2.4–12.4), conversion to laparotomy (HR: 14.1; CI 95%: 4.0–49.0), and severe surgical complications (Clavien-Dindo III–IV) (HR: 2.9; CI 95%: 1.5–5.5) were identified as predictors of a diminished overall survival. Conclusion Laterality disclosed no significant effect on the overall prognosis of colon cancer patients. However, group differences and distinct survival predictors could be identified in rCC and lCC patients.

Long-Term Clinical Outcomes of the Carpentier-Edwards Perimount Pericardial Bioprosthesis in Chinese Patients with Single or Multiple Valve Replacement in Aortic, Mitral, or Tricuspid Positions

Cardiology ◽  
2017 ◽  
Vol 138 (2) ◽  
pp. 97-106 ◽  
Author(s):  
Huiming Guo ◽  
Cong Lu ◽  
Huanlei Huang ◽  
Bin Xie ◽  
Jian Liu ◽  
...  
Keyword(s):  
Valve Replacement ◽  
Proportional Hazards ◽  
Survival Rates ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Clinical Results ◽  
Cox Proportional Hazards ◽  
Chinese Patients ◽  
Structural Valve Deterioration

Objectives: To report the safety and efficacy results of a 9- to 15-year follow-up investigation among patients who had received Carpentier-Edwards Perimount (CE-P) bovine pericardial bioprostheses (Edwards Lifesciences, Irvine, CA, USA) for valve replacement. Methods: This retrospective study investigated freedom from structural valve deterioration (SVD) as well as survival and reoperation among different age and etiology groups in patients who were implanted with a CE-P bioprosthesis at Guangdong General Hospital between 2001 and 2007. Kaplan-Meier survival analysis and multivariate Cox proportional hazards regression were performed. Results: The mean age of the patients (N = 225) was only 61.2 ± 11.5 years at valve replacement. More than half of the patients (55.1%) had rheumatic heart disease. The survival rates were 86.46, 81.58, and 74.42% at 5 years, 64.39, 66.19, and 55.85% at 10 years, and 48.37, 57.33, and 46.54% at 15 years for the groups with mitral valve replacement (MVR), aortic valve replacement (AVR), and double valve replacement (DVR), respectively. The median time to freedom from SVD was 12.5, 13.2, and 11.2 years, respectively, for patients with MVR, AVR, and DVR. A higher age at valve replacement was a significant risk factor for SVD in all patients (p < 0.01). Conclusions: Good long-term clinical results of CE-P valves have been demonstrated in Chinese patients >60 years.

Pretreatment hemoglobin level influences local control and survival of T1-T2 squamous cell carcinomas of the glottic larynx.

1995 ◽  
Vol 13 (8) ◽  
pp. 2077-2083 ◽  
Author(s):  
D A Fein ◽  
W R Lee ◽  
A L Hanlon ◽  
J A Ridge ◽  
C J Langer ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Head And Neck ◽  
Local Control ◽  
Squamous Cell ◽  
Proportional Hazards ◽  
Survival Rates ◽  
Local Control Rate ◽  
Cox Proportional Hazards ◽  
Hemoglobin Level ◽  
Cancer Center

PURPOSE A number of reports have documented the relationship between pretreatment hemoglobin level and local control and/or survival in the treatment of cervix, bladder, and advanced head and neck tumors. Consideration of correcting anemia before initiation of radiation therapy may prove increasingly important as clinical trials use intensive induction chemotherapy in the treatment of head and neck carcinomas. Neoadjuvant chemotherapy may produce anemia, which in turn may reduce the effectiveness of subsequent irradiation. MATERIALS AND METHODS One hundred nine patients with T1-2N0 squamous cell carcinoma of the glottic larynx were treated with definitive radiotherapy at the Fox Chase Cancer Center between June 1980 and November 1990. Follow-up times ranged from 26 to 165 months (median, 82). RESULTS The 2-year local control rate for patients who presented with a hemoglobin level < or = 13 g/dL was 66%, compared with 95% for patients with a hemoglobin level more than 13 g/dL (P = .0018). The 2-year survival rate for patients with a hemoglobin level < or = 13 g/dL was 46%, compared with 88% for patients with a hemoglobin level more than 13 g/dL (P < .001). Cox proportional hazards regression analysis showed that hemoglobin level (P = .0016) was the only variable that significantly influenced local control (P = .0016) and survival (P < .0001). CONCLUSION Patients who presented with hemoglobin levels more than 13 g/dL had significantly higher local control and survival rates. The strong apparent correlation between hemoglobin level, local control, and survival supports consideration of correcting anemia before initiation of radiation therapy.

Prolonged prophylaxis against venous thromboembolism with enoxaparin in patients undergoing cancer surgery: long-term survival analysis

2006 ◽  
Vol 21 (4) ◽  
pp. 195-198 ◽  
Author(s):  
D Bergqvist ◽  
G Agnelli ◽  
A T Cohen ◽  
P E Nilsson ◽  
A Le Moigne-Amrani ◽  
...  
Keyword(s):  
Survival Rates ◽  
Palliative Surgery ◽  
Curative Surgery ◽  
Term Survival ◽  
Long Term Survival ◽  
Significant Difference ◽  
One Year ◽  
Type Of Surgery

Objective: ENOXACAN II was a randomized, double-blind trial that showed prolonged (four-week) thromboprophylaxis with enoxaparin to be more effective than and as safe as standard (one-week) thromboprophylaxis in patients undergoing surgery with a curative intent for abdominopelvic cancer. This follow-up study compared long-term, all-cause mortality in both groups. Methods: Survival rates were calculated on the randomized, treated population ( n = 501). The primary efficacy endpoint was survival at one year. An exploratory analysis including survival data up to 44 months was performed. Because some patients were deemed to have undergone palliative as opposed to curative surgery, and there was a significant difference between the treatment groups in the percentage of patients undergoing palliative surgery, the survival analyses were adjusted for the type of surgery performed. Results: When adjusted for type of surgery, there was a trend towards reduced mortality among patients undergoing palliative surgery in the prolonged prophylaxis group (hazard ratio [HR] = 0.598, P = 0.3565) that became more pronounced beyond the pre-specified one year follow-up period (HR = 0.469, P = 0.078). This trend may reflect a beneficial effect of prolonged prophylaxis on survival in the palliative surgery group (one-year survival 65.4 versus 50% for standard prophylaxis). In patients undergoing curative surgery, one-year survival rates were equal in the standard and prolonged prophylaxis groups (93.8 and 93.2%, respectively). Conclusion: Prolonged thromboprophylaxis with enoxaparin may affect long-term survival in palliative surgery for cancer, but further investigation is warranted.

scholarly journals Long-term survival in patients who had CABG with or without prior coronary artery stenting

Open Heart ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. e001160
Author(s):  
Pratik Rai ◽  
Rebecca Taylor ◽  
Mohamad Nidal Bittar
Keyword(s):  
Coronary Artery ◽  
Proportional Hazards ◽  
Bypass Graft ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Term Survival ◽  
Long Term Survival ◽  
Significant Difference ◽  
The Impact

ObjectiveTo conduct a large-scale, single-centre retrospective cohort study to understand the impact of prior percutaneous coronary intervention (PCI) on long-term survival of patients who then undergo coronary artery bypass graft (CABG).MethodsBetween 1999 and 2017, a total of 11 332 patients underwent CABG at a hospital in the UK. The patients were stratified into those who received PCI (n=1090) or no PCI (n=10 242) prior to CABG. A total of 1058 patients from each group were matched using propensity score matching. Kaplan-Meier estimates were used to assess risk-adjusted survival in patients with prior PCI. Cox proportional hazards (CoxPH) model was then used to assess the effect of prior PCI and other variables in patients undergoing CABG.ResultsThe immediate postoperative outcome showed no difference in number of grafts per patients, blood transfusion, hospital stay or 30 days mortality between the groups. There was no significant difference in 5 years (90.8% vs 87.9), 10-year (76.5% vs 74.6%) and 15-year (64.4% vs 64.7%) survival between the non-PCI versus PCI groups. The Cox proportional hazards model further supports the null hypothesis as the PCI variable was found to be non-significant (CoxPH=1.03, p=0.75, CI=0.87–1.22) implying there was no difference in hazard of death for CABG patients with or without previous PCI. However, the model did yield information on the covariates that do affect the hazard of death.ConclusionThere is no difference in 5-year, 10-year and 15-year survival between patients undergoing CABG with or without prior PCI. However, certain patient, preoperative and intraoperative risk factors were identified with high hazard of death which needs to be investigated further.

scholarly journals Reinstitution of Mechanical Ventilation within 14 Days as a Poor Predictor in Prolonged Mechanical Ventilation Patients following Successful Weaning

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Mei-Lien Tu ◽  
Ching-Wan Tseng ◽  
Yuh Chyn Tsai ◽  
Chin-Chou Wang ◽  
Chia-Cheng Tseng ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Proportional Hazards ◽  
Prolonged Mechanical Ventilation ◽  
Care Center ◽  
Group Versus ◽  
Cox Proportional Hazards ◽  
Poor Predictor ◽  
Significant Difference ◽  
Successful Weaning ◽  
One Year

Although many parameters were investigated about weaning and mortality in critical patients in intensive units, no studies have yet investigated predictors in prolonged mechanical ventilation (PMV) patients following successful weaning. A cohort of 142 consecutive PMV patients with successful weaning in our respiratory care center was enrolled in this study. Successful weaning is defined as a patient having smooth respiration for more than 5 days after weaning. The results showed as follows: twenty-seven patients (19%) had the reinstitution within 14 days, and 115 patients (81%) had the reinstitution beyond 14 days. Renal disease RIFLE-LE was associated with the reinstitution within 14 days (P=0.006). One year mortality rates showed significant difference between the two groups (85.2% in the reinstitution within 14 days group versus 53.1% in the reinstitution beyond 14 days;P<0.001). Kaplan-Meier analysis showed that age ≥70 years (P=0.04), ESRD (P=0.02), and the reinstitution within 14 days (P<0.001) were associated with one-year mortality. Cox proportional hazards regression model showed that only the reinstitution within 14 days was the independent predictor for mortality (P<0.001). In conclusion, the reinstitution within 14 days was a poor predictor for PMV patients after successful weaning.

scholarly journals Effect of Statin Intensity on the Progression of Cardiac Allograft Vasculopathy

2021 ◽  
Vol 7 ◽  
Author(s):  
Tracey M Ellimuttil ◽  
Kimberly Harrison ◽  
Allman T Rollins ◽  
Irene D Feurer ◽  
Scott A Rega ◽  
...  
Keyword(s):  
Cardiac Transplantation ◽  
Proportional Hazards ◽  
Cardiac Allograft Vasculopathy ◽  
Cox Proportional Hazards ◽  
Cardiac Allograft ◽  
Allograft Vasculopathy ◽  
Free Survival ◽  
Kaplan Meier ◽  
Significant Difference

Background: In the non-transplant population, hyperlipidaemia has shifted from targeting LDL goals to statin intensity-based treatment. It is unknown whether this strategy is also beneficial in cardiac transplantation. Methods: This single-centre retrospective study evaluated the effect of statin use and intensity on time to cardiac allograft vasculopathy (CAV) after cardiac transplantation. Kaplan–Meier and Cox proportional hazards regression survival methods were used to assess the association of statin intensity and median post-transplant LDL on CAV-free survival. Results: The study involved 143 adults (71% men, average follow-up of 25 ± 14 months) who underwent transplant between 2013 and 2017. Mean CAV-free survival was 47.5 months (95% CI [43.1–51.8]), with 29 patients having CAV grade 1 or greater. Median LDL was not associated with time to CAV (p=0.790). CAV-free survival did not differ between intensity groups (p=0.435). Conclusion: Given the non-statistically significant difference in time to CAV with higher intensity statins, the data suggest that advancing moderate- or high-intensity statin after cardiac transplantation may not provide additional long-term clinical benefit. Trial registration: Not applicable.

scholarly journals A206 EVOLUTION OF PEDIATRIC AUTOIMMUNE CHOLANGITIS AND PRIMARY SCLEROSING CHOLANGITIS INTO ADULTHOOD

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 234-236
Author(s):  
P Willems ◽  
J Hercun ◽  
C Vincent ◽  
F Alvarez
Keyword(s):  
Primary Sclerosing Cholangitis ◽  
Sclerosing Cholangitis ◽  
Response To Treatment ◽  
Similar Proportion ◽  
Autoimmune Cholangitis ◽  
Significant Difference ◽  
One Year ◽  
Liver Tests

Abstract Background The natural history of primary sclerosing cholangitis (PSC) in children seems to differ from PSC in adults. However, studies on this matter have been limited by short follow-up periods and inconsistent classification of patients with autoimmune cholangitis (AIC) (or overlap syndrome). Consequently, it remains unclear if long-term outcomes are affected by the clinical phenotype. Aims The aims of this is study are to describe the long-term evolution of PSC and AIC in a pediatric cohort with extension of follow-up into adulthood and to evaluate the influence of phenotype on clinical outcomes. Methods This is a retrospective study of patients with AIC or PSC followed at CHU-Sainte-Justine, a pediatric referral center in Montreal. All charts between January 1998 and December 2019 were reviewed. Patients were classified as either AIC (duct disease on cholangiography with histological features of autoimmune hepatitis) or PSC (large or small duct disease on cholangiography and/or histology). Extension of follow-up after the age of 18 was done for patients followed at the Centre hospitalier de l’Université de Montréal. Clinical features at diagnosis, response to treatment at one year and liver-related outcomes were compared. Results 40 patients (27 PSC and 13 AIC) were followed for a median time of 71 months (range 2 to 347), with 52.5% followed into adulthood. 70% (28/40) had associated inflammatory bowel disease (IBD) (78% PSC vs 54% AIC; p=0.15). A similar proportion of patients had biopsy-proven significant fibrosis at diagnosis (45% PSC vs 67% AIC; p=0.23). Baseline liver tests were similar in both groups. At diagnosis, all patients were treated with ursodeoxycholic acid. Significantly more patients with AIC (77% AIC vs 30 % PSC; p=0.005) were initially treated with immunosuppressive drugs, without a significant difference in the use of Anti-TNF agents (0% AIC vs 15% PSC; p= 0.12). At one year, 55% (15/27) of patients in the PSC group had normal liver tests versus only 15% (2/13) in the AIC group (p=0.02). During follow-up, more liver-related events (cholangitis, liver transplant and cirrhosis) were reported in the AIC group (HR=3.7 (95% CI: 1.4–10), p=0.01). Abnormal liver tests at one year were a strong predictor of liver-related events during follow-up (HR=8.9(95% CI: 1.2–67.4), p=0.03), while having IBD was not (HR=0.48 (95% CI: 0.15–1.5), p=0.22). 5 patients required liver transplantation with no difference between both groups (8% CAI vs 15% CSP; p=0.53). Conclusions Pediatric patients with AIC and PSC show, at onset, similar stage of liver disease with comparable clinical and biochemical characteristics. However, patients with AIC receive more often immunosuppressive therapy and treatment response is less frequent. AIC is associated with more liver-related events and abnormal liver tests at one year are predictor of bad outcomes. Funding Agencies None

scholarly journals Perioperative Geriatric Assessment as A Predictor of Long-Term Hepatectomy Outcomes in Elderly Patients with Hepatocellular Carcinoma

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 842
Author(s):  
Masaki Kaibori ◽  
Hideyuki Matsushima ◽  
Morihiko Ishizaki ◽  
Hisashi Kosaka ◽  
Kosuke Matsui ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Geriatric Assessment ◽  
Proportional Hazards ◽  
Prognostic Indicator ◽  
Cox Proportional Hazards ◽  
Rate Of Change ◽  
Score Change ◽  
Comorbidity Burden ◽  
Reduction Group

This retrospective study recorded pertinent baseline geriatric assessment variables to identify risk factors for recurrence-free survival (RFS) and overall survival (OS) after hepatectomy in 100 consecutive patients aged ≥70 years with hepatocellular carcinoma. Patients had geriatric assessments of cognition, nutritional and functional statuses, and comorbidity burden, both preoperatively and at six months postoperatively. The rate of change in each score between preoperative and postoperative assessments was calculated by subtracting the preoperative score from the score at six months postoperatively, then dividing by the score at six months postoperatively. Patients with score change ≥0 comprised the maintenance group, while patients with score change <0 comprised the reduction group. The change in Geriatric 8 (G8) score at six months postoperatively was the most significant predictive factor for RFS and OS among the tested geriatric assessments. Five-year RFS rates were 43.4% vs. 6.7% (maintenance vs. reduction group; HR, 0.19; 95%CI, 0.11–0.31; p < 0.001). Five-year OS rates were 73.8% vs. 17.8% (HR, 0.12; 95%CI, 0.06–0.25; p < 0.001). Multivariate Cox proportional hazards analysis showed that perioperative maintenance of G8 score was an independent prognostic indicator for both RFS and OS. Perioperative changes in G8 scores can help forecast postoperative long-term outcomes in these patients.

scholarly journals Is It Definitely Clear That Long-Term Survival after Breast Cancer Surgery Is Not Affected by Anaesthetics?

Cancers ◽  
2021 ◽  
Vol 13 (14) ◽  
pp. 3390
Author(s):  
Mats Enlund
Keyword(s):  
Breast Cancer ◽  
Survival Data ◽  
Retrospective Studies ◽  
Breast Cancer Surgery ◽  
Breast Cancer Patients ◽  
Term Survival ◽  
Long Term Survival ◽  
Significant Difference ◽  
One Year

Retrospective studies indicate that cancer survival may be affected by the anaesthetic technique. Propofol seems to be a better choice than volatile anaesthetics, such as sevoflurane. The first two retrospective studies suggested better long-term survival with propofol, but not for breast cancer. Subsequent retrospective studies from Asia indicated the same. When data from seven Swedish hospitals were analysed, including 6305 breast cancer patients, different analyses gave different results, from a non-significant difference in survival to a remarkably large difference in favour of propofol, an illustration of the innate weakness in the retrospective design. The largest randomised clinical trial, registered on clinicaltrial.gov, with survival as an outcome is the Cancer and Anesthesia study. Patients are here randomised to propofol or sevoflurane. The inclusion of patients with breast cancer was completed in autumn 2017. Delayed by the pandemic, one-year survival data for the cohort were presented in November 2020. Due to the extremely good short-term survival for breast cancer, one-year survival is of less interest for this disease. As the inclusions took almost five years, there was also a trend to observe. Unsurprisingly, no difference was found in one-year survival between the two groups, and the trend indicated no difference either.

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