OS7.6 Socioeconomic burden and associations with quality of life in meningioma patients

BACKGROUND

Socioeconomics affect the outcome of neurological patients, but the socioeconomic burden of brain tumors has not been studied in detail.

PATIENTS AND METHODS

This survey study in a clinically well-annotated cohort of meningioma patients was designed to explore socioeconomic status parameters at diagnosis and one year thereafter. The survey comprised level of education, profession, employment status, subjective work ability, monthly income and the EPICES social deprivation score. Quality of life (QoL) and symptom burden were queried utilizing the EORTC-QLQ-C30/BN20 and MDASI-BT. A multivariate binary regression model was applied to explore associations of socioeconomics with QoL.

RESULTS

Completed surveys were obtained from 249 of 410 patients (61%) who were invited to participate. The level of education was an apprenticeship or higher in 214 patients (86%). One year after diagnosis, there was a 20% decline in the fraction of employed patients and a more than twofold increase in unemployment and disability (p<0.001). There was a decrease in monthly income among patients with a baseline income below national average (p=0.008). On multivariate analyses, there was an association of inferior QoL with pre-operative unemployment or retirement (OR 2.43, 95% CI 1.02–5.88), whereas a subjective work ability of >70% was associated with better QoL (OR 0.37, 95% CI 0.15–0.92).

CONCLUSION

Socioeconomics assessments should be incorporated in prospective neuro-oncology clinical trials. A more detailed knowledge of the effects of socioeconomics on patient outcome will aid in identifying patients at risk for deterioration and allow to implement improved preventive and supportive strategies.

Multimodality imaging evaluation before transcatheter aortic valve implantation: incidence of contrast medium-induced acute kidney injury, risk factors and prognosis

AIM

To evaluate the incidence, risk factors, and prognostic implications of contrast medium-induced acute kidney injury (CI-AKI) in patients undergoing transcatheter aortic valve implantation (TAVI) evaluation.

MATERIALS AND METHODS

Datasets from 98 out of 207 consecutive patients referred for multidetector computed tomography (MDCT) for TAVI evaluation were eligible for evaluation and were analysed retrospectively. The incidence of CI-AKI was correlated to outcome and to potential risk factors: kidney function (estimated glomerular filtration rate [eGFR]), heart failure, diabetes, amount of contrast medium, and duration of examination period.

RESULTS

CI-AKI occurred in 67 patients (68.4%) and mainly correlated with eGFR (p=0.01) and the amount of contrast medium as a function of eGFR (p=0.04). CI-AKI occurred before TAVI in 36 (53.7%) patients of which 13 (19.4%) did not undergo TAVI. In-hospital all-cause mortality was 21.4%, and of those 21 patients, 18 (85.7%) had CI-AKI and nine (42.9%) did not undergo TAVI. One-year all-cause mortality was 39.8%, and of those 39 patients who died within 1 year, 31 (79.5%) had CI-AKI.

CONCLUSION

CI-AKI mostly occurs already before TAVI as a consequence of pre-procedural imaging, which therefore represents the main contributor for CI-AKI in relation to TAVI. Regarding the observation that some patients will ultimately have no benefit because TAVI is not performed and the poor prognosis linked to CI-AKI should encourage improvement in patient selection when referring to pre-procedural imaging.

Anti-microbial stewardship: antibiotic use in well-appearing term neonates born to mothers with chorioamnionitis

OBJECTIVE

To determine if implementation of a protocol based on a neonatal early-onset sepsis (EOS) calculator developed by Kaiser Permanente would safely reduce antibiotic use in well-appearing term infants born to mothers with chorioamnionitis in the unique setting of an Observation Nursery.

STUDY DESIGN

Data obtained from a retrospective chart review of well-appearing term infants born between 2009 and 2016 were entered into the EOS calculator to obtain management recommendations.

RESULTS

Three hundred and sixty-two infants met the study criteria. Management according to the EOS calculator would reduce antibiotic use from 99% to 2.5% (P<0.0001) of patients. Average length of therapy would also decrease from 2.08 to 0.05 days (P<0.0001). One infant, who remained asymptomatic, had Enterococcus bacteremia and received a 7-day course of broad-spectrum antibiotics.

CONCLUSIONS

Culture-positive sepsis in asymptomatic neonates born to mothers with chorioamnionitis is rare. Management according to the EOS calculator would markedly reduce the potential complications of antibiotic use. These data should initiate re-examination of existing protocols for management of this cohort of patients.