Long-term survival and functional outcomes of critically ill patients with hematologic malignancies: a Canadian multicenter prospective study.

PURPOSE: Patients with hematologic malignancy (HM) commonly develop critical illness. Their long-term survival and functional outcomes have not been well described. METHODS: We conducted a prospective, observational study of HM patients admitted to seven Canadian intensive care units (ICUs) (2018-2020). We followed survivors at 7 days, 6 months and 12 months following ICU discharge. The primary outcome was 12-month survival. We evaluated functional outcomes at 6 and 12 months using the functional independent measure (FIM) and short form (SF)-36 as well as variables associated with 12-month survival. RESULTS: We enrolled 414 patients including 35% women. The median age was 61 (interquartile range, IQR: 52-69), median Sequential Organ Failure Assessment (SOFA) score was 9 (IQR: 6-12), and 22% had moderate-severe frailty (clinical frailty scale [CFS] ≥ 6). 51% had acute leukemia, 38% lymphoma/multiple myeloma, and 40% had received a hematopoietic stem cell transplant (HCT). The most common reasons for ICU admission were acute respiratory failure (50%) and sepsis (40%). Overall, 203 (49%) were alive 7 days post-ICU discharge (ICU survivors). Twelve-month survival of the entire cohort was 21% (43% across ICU survivors). The proportion of survivors with moderate-severe frailty was 42% (at 7 days), 14% (6 months), and 8% (12 months). Median FIM at 7 days was 80 (IQR: 50-109). Physical function, pain, social function, mental health, and emotional well-being were below age- and sex-matched population scores at 6 and 12 months. Frailty, allogeneic HCT, kidney injury, and cardiac complications during ICU were associated with lower 12- month survival. CONCLUSIONS: 49% of all HM patients were alive at 7 days post-ICU discharge, and 21% at 12 months. Survival varied based upon hematologic diagnosis and frailty status. Survivors had important functional disability and impairment in emotional, physical, and general well-being.

Survival Differences in Women with and without Autologous Breast Reconstruction after Mastectomy for Breast Cancer.

BACKGROUND: Breast reconstruction (BR) is an option for women who are treated with mastectomy; however, there has been concern regarding the oncologic safety of BR. In this study, we evaluated recurrences and mortality in women treated with mastectomy and compared outcomes in those treated with mastectomy alone to those with mastectomy plus transverse rectus adbominis (TRAM) flap BR. METHODS: The prospective cohort study included women treated with mastectomy at Women's College Hospital from 1987 to 1997. Women with TRAM flap BR were matched to controls based on age and year of diagnosis, stage, and nodal status. Patients were followed from the date of diagnosis until death or date of last follow-up. Hazard ratios were generated to compare cases and controls for outcome variables using Cox's proportional hazards models. RESULTS: Of 443 women with invasive breast cancer, 85 subjects had TRAM flap BR. Sixty-five of these women were matched to 115 controls. The mean follow-up was 11.2 (0.4-26.3) years. There were no significant differences between those with and without BR with weight, height, or smoking status. Women with TRAM flap were less likely to experience a distant recurrence compared to women without a TRAM flap (relative risk, 0.42; P = 0.0009) and were more likely to be alive (relative risk, 0.54; P = 0.03). CONCLUSIONS: Women who elect for TRAM flap BR after an invasive breast cancer diagnosis do have lower rates of recurrences and mortality than women treated with mastectomy alone. This cannot be explained by differences in various clinical or lifestyle factors.

Association of adipokines with obesity in children and adolescents.

BACKGROUND: Childhood obesity is a global epidemic and is associated with a higher risk of chronic diseases such as hypertension, diabetes mellitus and other metabolic disorders. Several adipokines including resistin, visfatin, leptin and adiponectin are synthesized and secreted by adipocytes, which play an important role in obesity. PATIENTS & METHODS: A total of 90 subjects (60 controls and 30 obese) between the ages of 5 and 18 years were selected. Serum visfatin, TNF-α, resistin, insulin and adiponectin were measured using ELISA and insulin resistance was calculated by the Homeostasis Model of Assessment-Insulin Resistance. RESULTS: Mean ± standard deviation Homeostasis Model of Assessment-Insulin Resistance, serum TNF-α and visfatin levels were significantly higher in obese subjects (3.99 ± 0.94, 12.99 ± 3.42, 10.89 ± 2.72, respectively) compared with the control group (1.60 ± 0.34, 7.22 ± 2.22 and 4.97 ± 1.57, respectively). Mean ± standard deviation serum adiponectin levels were significantly lower in obese children (5.95 ± 1.02) compared with controls (9.07 ± 1.25). Binary logistic regression shows that adiponectin and visfatin are associated with obesity. CONCLUSION: Circulating levels of adipokines vary in obesity and adiponectin and visfatin are associated with obesity.