PURPOSECritically ill elderly patients who suffer from Sars-CoV-2 disease are at high risk for organ failure. The modified MELD-XI score has not been evaluated for outcome prediction in these most vulnerable patients.METHODSThe Corona Virus disease (COVID19) in Very Elderly Intensive Care Patients study (COVIP, NCT04321265) prospectively recruited patients on intensive care units (ICU), who were = 70 years. Data were collected from March 2020 to February 2021. The MELD-XI score was calculated using the highest serum bilirubin and creatinine on ICU admission. Univariate and multivariable logistic regression analyses were performed to assess associations between the MELD-XI score and mortality. The primary outcome was 30-day-mortality, the secondary outcomes were ICU- and 3-month-mortality.RESULTSIn total, data from 2,993 patients were analyzed. Most patients had a MELD-XI <12 on admission (76%). The patients with MELD-XI = 12 had a significantly higher 30-day-, ICU- and 3-month-mortality (44%vs 64%, and 42%vs. 59%, and 57%vs. 76%, p < 0.001). After adjustment for multiple confounders, MELD-XI = 12 remained significantly associated with 30-day- (aOR 1.572, CI 1.268-1.949, p < 0.001), ICU-, and 3-month-mortality.CONCLUSIONIn critically ill elderly intensive care patients with COVID-19, the MELD-XI score constitutes a valuable tool for an early outcome prediction.
Rationale: Allo-HSCT is a potentially curative therapy for patients with sALCL who relapse or fail to respond to 1st-line therapy. Brentuximab vedotin (BV) is an anti-CD30 antibody-drug conjugate approved for treatment of R/R sALCL, but its potential effect as a bridge to allo-HSCT is largely unknown. The objective of this study was to analyze the results of allo-HSCT in R/R sALCL with special emphasis on the role of BV before allo-HSCT. Patients and Methods: Forty-four patients [24 women, median age at HSCT 39 (19–67) years] with sALCL were reported to the EBMT Lymphoma Database between January 2010 and December 2014; 23 patients were ALK positive, and 20 were negative. Time interval between diagnosis and allo-HSCT was 17 (5.5–106) mo, 25 patients (57%) had received ≥3 lines of therapy before transplant, and 50% of the patients had failed a prior auto-HSCT; 20 patients were allografted using HLA identical sibling donors, in 21 (48%) conditioning regimen was of reduced intensity and 34 patients (79%) had chemosensitive disease at the time of transplant. Results: A total of 23 patients (52%) received BV before allo-HSCT (median time from BV start date to SCT is 3.8 months (IQR 1.8–5.7)); there were no significant differences between them and the non-BV group with the exception of number of treatment lines before allo-HSCT (38% received 3 or more lines in the non-BV group vs 74% in the BV group, p = 0.04). Median number of BV doses received was 4 (1–16); 73% (n = 17) of the patients received BV either as second line [7 patients (30%)] or third line [10 patients (43%)] of therapy. Overall response rate was 87% [52% complete remission (CR)], and median number of doses to achieve the best response was 3 (2–7); 3-year non-relapse mortality (NRM) and incidence of relapse (IR) after allo-HSCT were 6.9 (95% 1.7–17.1) and 40% (95% 25–54.6) for the whole series, respectively, with no significant differences between the BV and non-BV groups; 1-year cumulative incidence of acute graft versus host disease (aGVHD) and chronic GVHD were 30% (95%CI 15–47) and 48% (95%CI 32–62), respectively. With a median follow up of 39 (12–69) mo for alive patients, 3-year progression-free survival (PFS) and overall survival (OS) were 53% (95% 40–71) and 74% (95% 61–89), respectively, with no significant differences between both groups of patients. Univariate analysis showed that number of treatment lines (more than 3) and disease status at allo-HSCT (remission) were the only adverse prognostic factor for both IR and PFS (p = 0.04 and 0.01 for IR and p = 0.03 and 0.001 for PFS, respectively). OS was lower and incidence of chronic GVHD higher in the ALK negative group (p = 0.04 and p = 0.02, respectively). Conclusions: Allo-HSCT is a valid treatment strategy for patients with R/R sALCL with more than 50% of the patients alive and disease-free 3 years after the procedure. In this analysis, the use of BV before allo-HSCT does not seem to hamper the long-term outcomes of this strategy. Keywords: allogeneic stem cell transplant (alloSCT); anaplastic large cell lymphoma (ALCL); brentuximab vedotin.
Objective: The objective of the study was to assess and to explain variation of organizational performance in intensive care units (ICUs). Design: This was a prospective multicenter study. Setting: The study involved 26 ICUs located in the Paris area, France, participating in a regional database. Methods: Data were collected through answers of 1000 ICU personnel to the Culture, Organization, and Management in Intensive Care questionnaire and from the database. Organizational performance was assessed through a composite score related to 5 dimensions: coordination and adaptation to uncertainty, communication, conflict management, organizational change, and organizational learning, Skills developed in relationship with patients and their families. Statistical comparisons between ICUs were performed by analysis of variance with a Scheffe pairwise procedure. A multilevel regression model was used to analyze both individual and structural variables explaining differences of ICU's organizational performance. Results: The organizational performance score differed among ICUs. Some cultural values were negatively correlated with a high level of organizational performance, suggesting improvement potential. Several individual and structural factors were also related to the quality of ICU organization, including absence of burnout, older staff, satisfaction to work, and high workload (P b.02 for each).
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