1
|
Patricio MD, Lagos TB, Tan AD, Tortosa CJ, Permejo CC. Nutrition and frailty status of patients undergoing cardiovascular surgery and its association with postoperative outcomes. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Malnutrition is a component of Frailty Syndrome characterized by weakness, poor nutritional status and reduced cognitive function. Frailty has been recognized to adversely affect post Cardiovascular Surgery outcomes in the elderly. In developing countries, Frailty can occur in younger patients from Rheumatic Heart Disease and earlier onset of Atherosclerotic Cardiovascular Disease. There is limited data on frailty in the young.
Methods
Malnutrition and Frailty were assessed preoperatively in 111 adult patients undergoing Cardiovascular Surgery from October 2020 to February 2021. Nutrition Risk Screening Tool (NRS) and Clinical Frailty Scale (CFS) were used for assessment respectively. Their in-hospital postoperative outcomes was then observed.
Results
There were 57 patients (51%) diagnosed with malnutrition, 26 (23%) of which were also Frail. Advanced age, Rheumatic Heart Disease, Heart Failure and Chronic Kidney Disease was significantly higher in malnutrition and frail group. After multivariate analysis, mortality rate (odds ratio [OR] 7.8; 95% confidence interval [CI]: 1.45 - 41.91; P=.017), prolonged hospitalization (OR: 5.96; 95% CI: 2.14–16.53; P=.001), mechanical ventilation (OR: 7.56; 95% CI: 1.81–31.62; P=.006) and nosocomial infections (OR: 13.57; 95% CI: 4.41–41.76; P≤.001) were found higher in patients with malnutrition and frailty.
Conclusion
Evaluation of nutrition and frailty status using NRS and CFS was helpful in predicting postoperative outcomes. With a significant number of this population having Malnutrition and Frailty, there is a need to strengthen clinical pathways on perioperative nutrition and rehabilitation with the possibility of improving Cardiovascular Surgery outcomes.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- M D Patricio
- Philippine Heart Center, Department of Ambulatory, Emergency and Critical Care, Division of Critical Care Cardiology, Quezon, Philippines
| | - T B Lagos
- Philippine Heart Center, Department of Ambulatory, Emergency and Critical Care, Division of Critical Care Cardiology, Quezon, Philippines
| | - A D Tan
- Philippine Heart Center, Department of Ambulatory, Emergency and Critical Care, Division of Critical Care Cardiology, Quezon, Philippines
| | - C J Tortosa
- Philippine Heart Center, Department of Ambulatory, Emergency and Critical Care, Division of Critical Care Cardiology, Quezon, Philippines
| | - C C Permejo
- Philippine Heart Center, Department of Ambulatory, Emergency and Critical Care, Division of Critical Care Cardiology, Quezon, Philippines
| |
Collapse
|
2
|
Guo JC, Zhang P, Zhou L, You L, Liu QF, Zhang ZG, Sun B, Liang ZY, Lu J, Yuan D, Tan AD, Sun J, Liao Q, Dai MH, Xiao GG, Li S, Zhang TP. Prognostic and predictive value of a five-molecule panel in resected pancreatic ductal adenocarcinoma: A multicentre study. EBioMedicine 2020; 55:102767. [PMID: 32361251 PMCID: PMC7195527 DOI: 10.1016/j.ebiom.2020.102767] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/15/2020] [Accepted: 04/09/2020] [Indexed: 02/06/2023] Open
Abstract
Background Pancreatic ductal adenocarcinoma (PDAC) has a devastating prognosis. The performance of clinicopathologic parameters and molecules as prognostic factors remains limited and inconsistent. The present study aimed to construct a multi-molecule biomarker panel to more accurately predict post-resectional prognosis of PDAC patients. Methods Firstly, a novel computational strategy integrating prognostic evidence from omics and literature on the basis of bioinformatics prediction (CIPHER) to generate the network, was designed to systematically identify potential high-confidence PDAC-related prognostic candidates. After specimens from 605 resected PDAC patients were retrospectively collected, 23 candidates were detected immunohistochemically in tissue-microarrays for the development cohort to construct a multi-molecule panel. Lastly, the panel was validated in two independent cohorts. Findings According to the constructed five-molecule panel, disease-specific survival (DSS) was significantly poorer in high-risk patients than in low-risk ones in development cohort (HR 2.15, 95%CI 1.51–3.05, P<0.0001; AUC 0.67). In two validation cohorts, similar significant differences between the two groups were also observed (HR 3.18 and 3.31, 95%CI 1.89–5.37 and 1.78–6.16, All P<0.0001; AUC 0.72 and 0.73). In multivariate analyses, this panel was the sole prognosticator that was significant in each cohort. Furthermore, its predictive power for long-term survival, higher than its individual constituents, could be largely enhanced by combination with traditional clinicopathological variables. Finally, adjuvant chemotherapy (ACT) correlated with better DSS only in high-risk patients, uni- and multi-variately, in all the cohorts. Interpretation The novel prognostic panel developed by a systematically network-based strategy presents strong ability in prediction of post-resectional survival of PDAC patients. Furthermore, panel-defined high-risk patients might benefit more from ACT.
Collapse
Affiliation(s)
- Jun-Chao Guo
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China.
| | - Peng Zhang
- MOE Key Laboratory of Bioinformatics, TCM-X Center/Bioinformatics Division, BNRIST/Department of Automation, Tsinghua University, Beijing, China
| | - Li Zhou
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Lei You
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Qiao-Fei Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Zhi-Gang Zhang
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bei Sun
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhi-Yong Liang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Jun Lu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Da Yuan
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Ai-Di Tan
- MOE Key Laboratory of Bioinformatics, TCM-X Center/Bioinformatics Division, BNRIST/Department of Automation, Tsinghua University, Beijing, China
| | - Jian Sun
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Quan Liao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Meng-Hua Dai
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Gary Guishan Xiao
- School of Pharmaceutical Science and Technology, Dalian University of Technology, Dalian, China
| | - Shao Li
- MOE Key Laboratory of Bioinformatics, TCM-X Center/Bioinformatics Division, BNRIST/Department of Automation, Tsinghua University, Beijing, China.
| | - Tai-Ping Zhang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China.
| |
Collapse
|
3
|
Tan AD, Novotny PJ, Kaur JS, Buckner JC, Mowat RB, Paskett E, Sloan JA. QOL and Survival Comparisons by Race in Oncology Clinical Trials. J Cancer Clin Oncol 2016; 2:100112. [PMID: 28691116 PMCID: PMC5500226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Significant efforts have been made to increase access and accrual to clinical trials for minority cancer patients (MP). This meta-analysis looked for differences in survival and baseline quality of life (QOL) between MP and non-minority cancer patients (NMP). MATERIALS AND METHODS Baseline QOL and overall survival times from 47 clinical trials (6513 patients) conducted at Mayo Clinic Cancer Center/North Central Cancer Treatment Group were utilized. Assessments included Uniscale, Linear Analogue Self Assessment, Symptom Distress Scale (SDS), Profile of Mood States and Functional Assessment of Cancer Therapy - General, each transformed into a 0-100 scale with higher scores indicating better outcomes. This transformation involves subtracting the lowest possible value from the assessment, dividing by the range of the scale (the maximum minus the minimum), and multiplying by 100. Analyses included Fisher's Exact tests, linear regression, Kaplan-Meier curves, and Cox proportional hazards models. RESULTS Eight percent of patients self-reported as MP (0.45% American Indian/Alaskan Native, 0.7% Asian, 5% Black/African American, 1.5% Hispanic, 0.1% Native Hawaiian and 0.3% Other). MP had no meaningful deficits relative to non-MP in overall QOL but were slightly worse on FACT-G total score, physical, social/family, functional, and SDS nausea severity. MP with lung, neurological or GI cancers had significantly worse mean scores in nausea (58 vs. 69), sleep problems (34 vs. 54); emotional (53 vs. 74); and social/family (60 vs. 67), respectively. Regression models confirmed these results. After adjusting for disease site, there were no significant differences in survival. CONCLUSION MP on these clinical trials indicated small deficits in physical, social, and emotional subscales at baseline compared to NMP. Within cancer sites, MP experienced large deficits for selected QOL domains that bear further attention.
Collapse
Affiliation(s)
- AD Tan
- Alliance Statistics and Data Center, Division of Biomedical Statistics Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - PJ Novotny
- Alliance Statistics and Data Center, Division of Biomedical Statistics Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - JS Kaur
- Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - JC Buckner
- Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - RB Mowat
- Bixby Medical Center/Hickman Cancer Center, Sylvania, Ohio, USA
| | - E Paskett
- College of Medicine, Ohio State University, Columbus, OH, USA
| | - JA Sloan
- Alliance Statistics and Data Center, Division of Biomedical Statistics Informatics, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|