Liver Transplantation for HCC in HIV-Infected Patients: Long-Term Single-Center Experience

Background: HIV-infected patients now have long life expectation since the introduction of the highly active antiretroviral therapy (HAART). Liver diseases, especially cirrhosis and hepatocellular carcinoma (HCC), currently represent a leading cause of death in this setting of patients. Aim: To address the results of liver transplantation (LT) for HCC in HIV-infected patients. Methods: All patients with and without HIV infection who underwent LT for HCC (n = 420) between 2001 and 2021 in our center were analyzed with the intent of comparing graft and patient survival. Cox regression analysis was used to determine prognostic survival factors and logistic regression to determine the predictor factors of post-LT recurrence. Results: Among 1010 LT, 32 were HIV-infected recipients. With an average follow-up of 62 ± 51 months, 5-year overall survival in LT recipients with and without HIV-infection was 71.6% and 69.9%, respectively (p = ns), whereas 5-year graft survival in HIV-infected and HIV-non infected was 68.3% and 68.2%, respectively (p = ns). The independent predictive factor of survival in the study group was: HCV infection (HR 1.83, p = 0.024). There were no significant differences in the pathological characteristics of HCC between the two groups. The logistic regression analysis of the study population demonstrated that microvascular invasion (HR 5.18, p< 0.001), HCC diameter (HR 1.16, p = 0.028), and number of HCC nodules (HR 1.26, p = 0.003) were predictors of recurrence post-LT. Conclusion: Our study shows that HIV patients undergoing LT for HCC have comparable results in terms of post-LT survival. Excellent results can be achieved for HIV-infected patients with HCC, as long as a strategy of close surveillance and precise treatment of the tumor is adopted while on the waiting list.

Download Full-text

NLRP3 is a Novel Prognostic Biomarker and Correlates With Immune Infiltrates in Lung Adenocarcinoma and Skin Cutaneous Melanoma

10.21203/rs.3.rs-880002/v1 ◽

2021 ◽

Author(s):

Chenxi Yuan ◽

Qingwei Wang ◽

Xueting Dai ◽

Yipeng Song ◽

Jinming Yu

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Lung Adenocarcinoma ◽

Immune Cells ◽

Cutaneous Melanoma ◽

Cox Regression ◽

Cox Regression Analysis ◽

Potential Biomarker ◽

The Impact ◽

Nlrp3 Expression

Abstract Background: Lung adenocarcinoma (LUAD) and skin cutaneous melanoma (SKCM) are common tumors around the world. However, the prognosis in advanced patients is poor. Because NLRP3 was not extensively studied in cancers, so that we aimed to identify the impact of NLRP3 on LUAD and SKCM through bioinformatics analyses. Methods: TCGA and TIMER database were utilized in this study. We compared the expression of NLRP3 in different cancers and evaluated its influence on survival of LUAD and SKCM patients. The correlations between clinical information and NLRP3 expression were analyzed using logistic regression. Clinicopathologic characteristics associated with overall survival in were analyzed by Cox regression. In addition, we explored the correlation between NLRP3 and immune infiltrates. GSEA and co-expressed gene with NLRP3 were also done in this study. Results: NLRP3 expressed disparately in tumor tissues and normal tissues. Cox regression analysis indicated that up-regulated NLRP3 was an independent prognostic factor for good prognosis in LUAD and SKCM. Logistic regression analysis showed increased NLRP3 expression was significantly correlated with favorable clinicopathologic parameters such as no lymph node invasion and no distant metastasis. Specifically, a positive correlation between increased NLRP3 expression and immune infiltrating level of various immune cells was observed. Conclusion: Together with all these findings, increased NLRP3 expression correlates with favorable prognosis and increased proportion of immune cells in LUAD and SKCM. These conclusions indicate that NLRP3 can serve as a potential biomarker for evaluating prognosis and immune infiltration level.

Download Full-text

Expression of LOX Suggests Poor Prognosis in Gastric Cancer

Frontiers in Medicine ◽

10.3389/fmed.2021.718986 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jinfeng Zhu ◽

Chen Luo ◽

Jiefeng Zhao ◽

Xiaojian Zhu ◽

Kang Lin ◽

...

Keyword(s):

Gene Expression ◽

Gastric Cancer ◽

Logistic Regression ◽

Regression Analysis ◽

Poor Prognosis ◽

Cox Regression ◽

Gene Set Enrichment Analysis ◽

High Expression ◽

Expression Level ◽

Cox Regression Analysis

Background: Lysyl oxidase (LOX) is a key enzyme for the cross-linking of collagen and elastin in the extracellular matrix. This study evaluated the prognostic role of LOX in gastric cancer (GC) by analyzing the data of The Cancer Genome Atlas (TCGA) and the Gene Expression Omnibus (GEO) dataset.Methods: The Wilcoxon rank-sum test was used to calculate the expression difference of LOX gene in gastric cancer and normal tissues. Western blot and immunohistochemical staining were used to evaluate the expression level of LOX protein in gastric cancer. Kaplan-Meier analysis was used to calculate the survival difference between the high expression group and the low expression group in gastric cancer. The relationship between statistical clinicopathological characteristics and LOX gene expression was analyzed by Wilcoxon or Kruskal-Wallis test and logistic regression. Univariate and multivariate Cox regression analysis was used to find independent risk factors affecting the prognosis of GC patients. Gene set enrichment analysis (GSEA) was used to screen the possible mechanisms of LOX and GC. The CIBERSORT calculation method was used to evaluate the distribution of tumor-infiltrating immune cell (TIC) abundance.Results: LOX is highly expressed in gastric cancer tissues and is significantly related to poor overall survival. Wilcoxon or Kruskal-Wallis test and Logistic regression analysis showed, LOX overexpression is significantly correlated with T-stage progression in gastric cancer. Multivariate Cox regression analysis on TCGA and GEO data found that LOX (all p < 0.05) is an independent factor for poor GC prognosis. GSEA showed that high LOX expression is related to ECM receptor interaction, cancer, Hedgehog, TGF-beta, JAK-STAT, MAPK, Wnt, and mTOR signaling pathways. The expression level of LOX affects the immune activity of the tumor microenvironment in gastric cancer.Conclusion: High expression of LOX is a potential molecular indicator for poor prognosis of gastric cancer.

Download Full-text

Risk Factors for Leukemic Transformation Among 1,306 Patients with Primary Myelofibrosis: Mutations Predict Early Events

Blood ◽

10.1182/blood-2018-99-109895 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 3044-3044

Author(s):

Rangit Reddy Vallapureddy ◽

Mythri Mudireddy ◽

Natasha Szuber ◽

Domenico Penna ◽

Maura Nicolosi ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

High Risk ◽

Cox Regression ◽

Primary Myelofibrosis ◽

Idh1 Mutation ◽

Severe Anemia ◽

Cox Regression Analysis ◽

Version 2.0

Abstract Background: Current prognostic models in primary myelofibrosis (PMF) target overall survival (OS) and utilize MIPSS70 (mutation-enhanced international prognostic scoring system for transplant-age patients), MIPSS70+ version 2.0 (karyotype-enhanced MIPSS70) and GIPSS (genetically-inspired prognostic scoring system, which is based on mutations and karyotype) (JCO 2018;36:310; JCO doi: 10.1200/JCO.2018.78.9867; Leukemia. 2018;doi:10.1038/s41375-018-0107). In the current study, we used logistic regression statistics to identify risk factors for leukemic transformation (LT) within 5 years of diagnosis/referral (i.e. early events) and also performed Cox regression analysis of overall leukemia-free survival (LFS). Methods : Study patients were recruited from the Mayo Clinic, Rochester, MN, USA. Diagnoses of LT and chronic phase PMF were confirmed by both clinical and bone marrow examinations, in line with the 2016 World Health Organization criteria (Blood. 2016;127:2391); specifically, LT required presence of ≥20% blasts in the peripheral blood (PB) or bone marrow (BM) (Blood 2016;127:2391). Statistical analyses considered clinical and laboratory data collected at the time of initial PMF diagnosis or Mayo Clinic referral point. Logistic regression statistics was used to identify predictors of LT at 5 years from initial diagnosis/referral; in the particular method, patients with documented LT within 5 years were "uncensored" while those followed up for at least 5 years, without developing LT, were "censored"; the analysis excluded patients without LT and not followed for at least 5 years. In addition, Cox regression analysis was performed to identify risk factors for overall LFS. The JMP® Pro 13.0.0 software from SAS Institute, Cary, NC, USA, was used for all calculations. Results: 1,306 patients with PMF (median age 65 years; 63% males) were included in the current study; MIPSS70+ version 2.0 risk distribution was 20% very high risk, 41% high risk, 19% intermediate risk, 16% low risk and 4% very low risk. 149 (11%) patients were documented to experience LT, and compared to the remaining patients (n=1157), they were more likely to be males (p=0.02) and mutated for ASXL1 (p=0.01), SRSF2 (0.001) and IDH1 (0.02) and present with higher risk MIPSS70+ version 2.0 (p=0.02). Multivariable logistic regression identified the following as predictors of LT in the first 5 years of disease: IDH1 mutation (odds ratio; OR 78.4), very high risk (VHR) karyotype (OR 57.6), ASXL1 mutation (OR 15.1), age >70 years (OR 13.3), SRSF2 mutation (OR 8.5), male sex (OR 6.9), PB blasts ≥3% (OR 5.4), presence of moderate or severe anemia, adjusted for sex (OR 3.6) and constitutional symptoms (OR 3.1). On Cox regression analysis, the following were associated with inferior LFS: IDH1 mutation (HR 4.3), PB blasts ≥3% (HR 3.3), SRSF2 mutation (HR 3.0), age >70 years (HR 2.1), ASXL1 mutation (HR 2.0) and presence of moderate or severe anemia, adjusted for sex (HR 1.9). Subsequently, HR-based risk point allocation resulted in highly discriminating LT predictive model with HR (95% CI) of 39.4 (10.8-114) for high risk and 4.1 (2.4-7.3) for intermediate risk (Figure 1). Conclusions: The current study identifies IDH1 mutation as a main predictor of LT in PMF. Our study also implicates SRSF2 and ASXL1 mutations and VHR karyotype as other genetic markers of early LT. Other independent contributors of early LT and inferior LFS, overall, included PB blasts ≥3%, moderate to severe anemia and older age. We provide LT prediction model, based on these variables, with leukemia risk ranging from 8% to 57%. Disclosures No relevant conflicts of interest to declare.

Download Full-text

Prevalence of Plantar Verrucae in Patients with Human Immunodeficiency Virus Infection During the Post–Highly Active Antiretroviral Therapy Era

Journal of the American Podiatric Medical Association ◽

10.7547/1010035 ◽

2011 ◽

Vol 101 (1) ◽

pp. 35-40 ◽

Cited By ~ 2

Author(s):

James Johnston ◽

Christy M. King ◽

Sky Shanks ◽

Saieh Khademi ◽

Joseph Nelson ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Logistic Regression ◽

Antiretroviral Therapy ◽

Life Expectancy ◽

Confidence Interval ◽

Hiv Infection ◽

Highly Active Antiretroviral Therapy ◽

Hiv Positive ◽

Highly Active ◽

Immunodeficiency Virus

Background: Since the implementation of highly active antiretroviral therapy (HAART), the life expectancy of patients with human immunodeficiency virus (HIV) has significantly increased. This is likely to cause changes in podiatric medical manifestations, such as plantar verrucae, in this population. Methods: Attendees at a San Francisco street fair in 2008 provided information about HIV status and the presence of verrucae via a survey. A total of 504 surveys were analyzed and compared with 1995 data, before HAART implementation. We examined if there was a statistically significant change in the increased likelihood of plantar verrucae in HIV-positive patients from 1995 to 2008. Then we examined the likelihood of HIV-positive patients (compared to HIV-negative patients) presenting with plantar verrucae in 2008, by using logistic regression, and controlling for age, sex, and race/ethnicity. Results: Patients with HIV infection were 5.2 times more likely to present with plantar verrucae compared to patients without HIV infection in 2008 (95% confidence interval, 2.5–11.0, P < .0001) and 10.0 times more likely in 1995 (95% confidence interval, 3.4–29.0, P < .0001). This decrease in likelihood over time was not statistically significantly different (P = .33). Logistic regression analysis controlling for the covariates of age, race, and sex showed that patients with HIV in 2008 were 4.5 times more likely to present with verrucae compared to patients without HIV (95% confidence interval, 2.1–9.9, P = .0002). Conclusions: Patients with HIV infection in 2008 are still significantly more likely to present with plantar verrucae after controlling for age, race, and sex. This increased likelihood has not changed significantly across time. Because HAART has increased the life expectancy of patients with HIV, this group of patients with plantar verrucae will continue to represent a significant population in the practice of podiatric medicine. (J Am Podiatr Med Assoc 101(1): 35–40, 2011)

Download Full-text

IMPACT OF METHADONE MAINTENANCE THERAPY ON HIV INCIDENCE IN PERAK, 2008 - 2017: A COX REGRESSION ANALYSIS

Malaysian Journal of Public Health Medicine ◽

10.37268/mjphm/vol.19/no.1/art.39 ◽

2019 ◽

Vol 19 (1) ◽

pp. 75-83

Author(s):

Hairul Izwan Abdul Rahman ◽

Nor Aida Sanusi ◽

Muhammad Syafik Ikhwan Salleh ◽

Ng Yoon Yeen ◽

Ismail Ali Mohd Jobran ◽

...

Keyword(s):

Regression Analysis ◽

Maintenance Therapy ◽

Hiv Infection ◽

Cox Regression ◽

Methadone Maintenance ◽

Demographic Data ◽

Methadone Maintenance Therapy ◽

Cox Regression Analysis ◽

Hiv Seroconversion ◽

The Impact

In 2005, Ministry of Health introduced the Needle Syringe Exchange Program (NSEP) and Methadone Maintenance Therapy (MMT) program as a part of Harm Reduction program to combat HIV infection in Malaysia among people who inject drug (PWIDs). Expenditures were estimated approximately RM10 millions per year to establish and sustain the NSEP and MMT centres. This study examined the impact of MMT program on preventing HIV seroconversion among registered MMT clients that are people who inject drug (PWIDs), and to identify other predictors of HIV seroconversion among this group. This was a retrospective cohort study done in the state of Perak involving a total of 212 randomly selected MMT clients registered between 2008-2017 in 6 clinics. This study looks at data collected from the last ten-year cohort from baseline to follow-up. A questionnaire was used to obtain socio-demographic data, sexual and drugs abuse history. Test results for HIV were obtained from medical records. Cox regression analysis was performed to examine factors associated with seroconversion and Kaplan-Meier analysis to estimate HIV survival time. This study displayed that both Methadone take home supply (HR 10.4, 95% CI: 1.6 – 68.8) and unprotected sexual practice (HR 5.9, 95%CI: 1.1 – 31.5) shown higher risks of HIV seroconversion compared to DOTS and condom practice among MMT clients respectively. Mean survival for HIV seroconversion among MMT clients was 104.44 (95%CI: 101.85 – 107.04) months. This study provides reliable evidence that MMT program markedly reduces incidence of HIV infection among people who inject drug (PWIDs).

Download Full-text

Risk Factors for the Morbidity and Prognosis of Lung Metastases in Newly Diagnosed Ovarian Carcinoma: A Large Population-based Study

10.21203/rs.3.rs-737681/v1 ◽

2021 ◽

Author(s):

Shuning Ding ◽

Kaibo Guo ◽

Linqin Wu ◽

Dongxu Li ◽

Peipei Wang ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Ovarian Carcinoma ◽

Cox Regression ◽

Lung Metastases ◽

Population Based ◽

Ca 125 ◽

Newly Diagnosed ◽

Cox Regression Analysis

Abstract Background: To evaluate the risk factors for the morbidity and prognosis of lung metastases (LM) in patients with newly diagnosed ovarian carcinoma (OC). Methods: Based on the Surveillance, Epidemiology, and End Results (SEER) dataset, OC patients from 2010 and 2016 were retrospectively analyzed. Risk factors for the morbidity of LM in OC patients and their survival were assessed by logistic regression analysis and Kaplan-Meier and Gray method, respectively. Cox regression analysis was performed to identify risk factors for the prognosis of OC patients with LM, and their prognostic potentials were further validated by two established nomograms.Results: There are 27,123 eligible OC patients were enrolled in the study, with the morbidity of LM at 5.61% (1,521/27,123). Logistic regression models illustrated that T3 stage [odds ratio (OR)=2.74, 95%CI=2.09-3.66, P<0.01], advanced N stage (OR=1.86, 95%CI=1.62-2.14, P<0.01), and the prevalence of bone metastasis (OR=3.78, 95%CI=2.79-5.11, P<0.01), brain metastasis (OR=4.67, 95%CI=2.50-8.63, P<0.01) and liver metastasis (OR=3.60, 95%CI=3.14-4.12, P<0.01) were all significantly correlated with the morbidity of LM in OC patients. Median survival for OC patients with LM was 11 months (interquartile range, 3 to 25 months). Cox regression analyses illustrated over 80 years of age [hazard ratio (HR)=2.52, 95%CI=2.33-2.72, P<0.01] and positive expression of cancer antigen 125 (CA-125, HR=1.63, 95%CI=1.47-1.82, P<0.01) were significantly correlated with the high mortality of LM, while chemotherapy (HR=0.62, 95%CI=0.59-0.65, P<0.01) was significantly correlated with the low mortality. Two nomograms were established to examine the concordance index (C-index), calibration curves, the area under the curve (AUC), decision curve analyses (DCAs) and clinical impact curves (CICs), which validated the prognostic potentials of identified risk factors in OC patients with LM. Conclusion: The population-based cohort study provides references for guiding clinical screening and individualized treatment of OC patients with LM.

Download Full-text

Diminished ovarian reserve is the major cause of infertility among women undergoing their first assisted reproductive technology treatment: a retrospective observational study

10.21203/rs.3.rs-124361/v1 ◽

2020 ◽

Author(s):

Mengqian Zhang ◽

Hongxian Zhang ◽

Rui Yang ◽

Guoshuang Feng ◽

Huiyu Xu ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Ovarian Reserve ◽

Cox Regression ◽

Classification Tree ◽

Diminished Ovarian Reserve ◽

Classification Tree Analysis ◽

Success Rates ◽

Tree Analysis ◽

Cox Regression Analysis

Abstract Background This study aims to investigate the effects of various factors on treatment outcomes in women undergoing in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI) with embryo transfer (ET). Methods Of the 8993 eligible women who underwent their first IVF/ICSI–ET cycles, and met our inclusion and exclusion criteria, 2742(30.5%) achieved clinical pregnancy while 6251(69.5%) did not. Multivariable Cox regression analysis, multiple logistic regression analysis, and classification tree analysis were used sequentially to screen key predictors among predictors of various infertility causes and ovarian stimulation protocols through the best subset technique. Results Multivariate Cox regression analysis showed that the main factor affecting fertility in first attempts at IVF/ICSI–ET is diminished ovarian reserve (DOR), with a hazard ratio (HR) of 0.406 and 95% confidence interval (CI) of 0.353–0.466. Multiple forward logistic regression with 5-fold cross-validation also found that, with an odds ratio (OR) of 2.522 (95% CI = 2.167–2.937), DOR affects fertility. The classification tree analysis was further used to better visualize the model. Conclusions DOR is the major factor affecting success rates in couples undergoing their first attempt at IVF/ICSI-ET. The selection of the most appropriate pairs for IVF/ICSI treatment can not only increase the success rates but also the cumulative cost-effectiveness.

Download Full-text

NCOA3: A molecular prognostic marker for melanoma

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.8007 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 8007-8007 ◽

Cited By ~ 1

Author(s):

J. Rangel ◽

S. Torabian ◽

L. Shaikh ◽

M. Nosrati ◽

J. R. Miller ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Cox Regression ◽

Prognostic Significance ◽

Primary Melanoma ◽

Tumor Location ◽

Tumor Thickness ◽

Rank Test ◽

Cox Regression Analysis ◽

Clark Level

8007 Background: Nuclear receptor coactivator-3 (NCOA3, also known as AIB1 or SRC-3), a member of the steroid receptor coactivator 1 family, has been shown to be amplified in human breast cancer. We recently identified NCOA3 as differentially expressed in metastatic melanomas by gene expression profiling, suggesting its role as a possible molecular prognostic factor. In this study, we assessed the prognostic significance of NCOA3 expression in a large melanoma patient cohort using tissue micro-arrays (TMAs). Methods: We used a commercially available antibody against NCOA3 to perform immunohistochemical analysis of NCOA3 expression in TMAs containing primary melanoma specimens from 353 patients seen at the UCSF Melanoma Center. Cases included clinicopathologic information (e.g., age, sex, tumor location, tumor thickness, Clark level and ulceration), as well as sentinel lymph node (SLN) status, and information regarding relapse-free (RFS) and disease-specific (DSS) survival. NCOA3 expression was assessed on a 4-point scale (0–3) by an observer blinded to patient outcomes. Results: High NCOA3 expression was significantly predictive of SLN metastasis by univariate logistic regression (p=0.015), and associated with a higher mean positive SLN count (p=0.03, Le test). Kaplan-Meier analysis demonstrated a significant association between increased NCOA3 expression and reduced RFS as well as DSS (p=0.024, and p=0.031 by log-rank test, respectively). Multivariate step-wise logistic regression analysis of 12 factors revealed NCOA3 expression, along with tumor thickness, age, vascular involvement, and Clark level to be independent predictors of SLN status. Multivariate Cox regression analysis showed the independent impact of NCOA3 expression on RFS and DSS with the inclusion of the AJCC factors tumor thickness, ulceration, Clark level, tumor location, patient age and sex. Conclusions: These results reveal NCOA3 to be a novel, independent marker of melanoma outcome, with a significant impact on SLN metastasis, RFS and DSS. No significant financial relationships to disclose.

Download Full-text

Predicting biochemical recurrence after prostatectomy: Can machine learning beat CAPRA score? Results of a multicentric retrospective analysis on 4,700 patients.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.6_suppl.343 ◽

2020 ◽

Vol 38 (6_suppl) ◽

pp. 343-343 ◽

Cited By ~ 1

Author(s):

Paul Sargos ◽

Nicolas Leduc ◽

Nicolas Giraud ◽

Giorgio Gandaglia ◽

Mathieu Roumiguie ◽

...

Keyword(s):

Neural Network ◽

Machine Learning ◽

Logistic Regression ◽

Regression Analysis ◽

Deep Learning ◽

Random Forest ◽

Biochemical Recurrence ◽

Cox Regression ◽

P Value ◽

Cox Regression Analysis

343 Background: Recent advances in machine learning algorithms and deep learning solutions paved the way for improved accuracy in survival analysis. We aim to investigate the accuracy of conventional machine learning and deep learning methods in the prediction of 3-year biochemical recurrence (BCR) as compared to CAPRA score prediction. Methods: A total of 5043 men who underwent RP between 2000 and 2015 for clinically localized PCa iwere analyzed retrospectively. Three-year BCR was predicted using the following models: CAPRA score, Cox regression analysis, logistic regression, k-nearest neighbor, random forest and densely connected feed-forward neural network classifier. The discrimination of the models was quantified using the C-index or the area under the receiver operating characteristics curve. Results: Patients with CAPRA score 2 and 3 accounted for 64% of the population. C-index measuring performance for the prediction of the three-year BCR for CAPRA score was 0.63. C-index values for k-neighbor classifier, logistic regression, Cox regression analysis, random forest classifier and densely optimized neural network were respectively 0.55, 0.63, 0.64, 0.64 and 0.70 (pairwise, adjusted p-value < 0.01). After inclusion of available post-surgical variables, C-index value reached respectively 0.58, 0.77, 0.74, 0.75 and 0.84 (pairwise, adjusted p-value < 0.05). Conclusions: Our results show that CAPRA score performed poorly in intermediate-risk patients undergoing RP. Densely connected neural networks with simple architecture further increased predictive power with low computational cost. In order to predict 3-years BCR, adding post-surgical features to the model greatly enhanced its performance.

Download Full-text

Hemorrhage from cerebral cavernous malformations

Neurology ◽

10.1212/wnl.0000000000009730 ◽

2020 ◽

Vol 95 (1) ◽

pp. e89-e96 ◽

Cited By ~ 1

Author(s):

Bixia Chen ◽

Annika Herten ◽

Dino Saban ◽

Steffen Rauscher ◽

Alexander Radbruch ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Cox Regression ◽

Binary Logistic Regression Analysis ◽

Cerebral Cavernous Malformations ◽

Cavernous Malformations ◽

Cox Regression Analysis ◽

Mode Of Presentation ◽

The Impact

ObjectiveTo determine the role of associated developmental venous anomalies (DVAs) in intracranial hemorrhage (ICH) caused by cerebral cavernous malformations (CCMs).MethodsWe analyzed patient registry data of 1,219 patients with cavernous malformations treated in our institution between 2003 and 2018. Patients with spinal and familial CCM and patients without complete MRI data were excluded. The impact of various variables on ICH as a mode of presentation was assessed with multivariate binary logistic regression analysis. Kaplan Meier/Cox regression analysis was performed to analyze cumulative 5-year-risk for (re)hemorrhage and to identify baseline predictors of this outcome.ResultsSeven hundred thirty-one patients with CCM were included. Multivariate logistic regression confirmed a statistically significant negative correlation with DVA (odds ratio [OR] 0.635 [95% confidence interval (CI) 0.459–0.878]) and positive correlation with brainstem localization (OR 6.277 [95% CI 4.287–9.191]) with ICH as the mode of presentation. Among 731 patients, 76 experienced (re)hemorrhage during 2,338 person-years of follow-up. Overall cumulative 5-year risk was 24.1% (95% CI 21.1%–27.5%). Cox regression analysis revealed initial presentation with ICH (hazard ratio [HR] 8.0 [95% CI 3.549–18.122]) and brainstem localization (HR 2.9 [95% CI 1.756–4.765]) as independent baseline predictors of (re)hemorrhage. Presence of DVA added no independent prognostic information (HR 1.1 [95% CI 0.717–1.885]).ConclusionPatients with CCM with associated DVA are at lower risk to present with ICH. During untreated 5-year follow-up, they showed equal (re)hemorrhage risk compared to patients with CCM without DVA.

Download Full-text