Data confirming parenteral nutrition (PN) as an independent risk factor for catheter-related infection (CRI) are scarce and not recent. This study aims to estimate the effect of PN on CRI in cancer patients after catheter placement. A retrospective cohort analysis of the French National Health Data System was conducted. A total of 5300 gastric, 5975 pancreatic, and 15,102 lung cancer patients with central venous catheter insertion between 2012 and 2016 were included. Potential confounders for CRI were evaluated using Poisson regression. Incidence rates (IRs) of CRI were calculated. Incidence rate ratio (IRR) was estimated to assess the effect of exposure to PN on infection occurrence in all patients and among patients receiving chemotherapy (CT). The independent risk factors found to be associated with CRI were age, sex, Charlson Comorbidity Index, PN, CT, metastasis, and history of infection. After adjustment, there was an increased risk of CRI in patients with versus without PN in gastric (IRR: 1.1165; 95% confidence interval [95% CI]: 1.0119-1.2319), pancreatic (IRR: 1.2071; 95% CI: 1.0985-1.3265), and lung cancer (IRR: 1.1850; 95% CI: 1.0832-1.2962). In patients who received PN, IRs of CRI were higher than in those who did not, for gastric (34.84% vs 29.69%, respectively; P = .0001), pancreatic (38.89% vs 28.58%, respectively; P < .0001), and lung (23.64% vs 22.13%, respectively; P = .0967) cancer cohorts. The results of this National administrative claims database analysis suggested that PN might be one of the independent risk factors for CRI. However, the risk was smaller than previously reported, regardless of whether the patient was receiving CT or not.

To assess the incidence (all lesions) of bladder cancer (BC) in France, describe patient characteristics and healthcare pathways during the first year after diagnosis, and estimate medical costs.

All adult patients with an initial BC diagnosis (ICD-10 codes: C67, D09.0, D41.4) in 2017 were selected from the French National Healthcare System Database. Patients were classified according to the most invasive surgical procedure they underwent. Treatments included cystectomy, transurethral resection of bladder tumor (TURBT), intravesical therapy, chemotherapy, and radiotherapy. Healthcare pathways were analyzed as sequences and grouped using hierarchical clustering. Medical costs during the first year of the disease were estimated for each cluster.

Out of 24,737 incident BC patients selected, the median age at diagnosis was 72 years, and 80.2% were men. Nearly 20% had received treatment for a cancer other than BC in the previous year. The majority (n = 9501, 38.4%) underwent TURBT only with a mean medical cost of €4435 [95% CI: 4322; 4548]. A total of 3037 patients (12.3%) underwent cystectomy as their initial treatment. The estimated costs for the group receiving intravesical instillations following a single TURBT (€6129 [5994; 6264]) were lower than those for the group with repeated TURBT (€9357 [9086; 9628]). Costs for patients who received systemic treatment after cystectomy were the highest at €25,636 [24,519; 26,752].

Our study estimates the incidence of BC in France, describes healthcare pathways at the national level, and analyses the associated economic burden.

In many countries where hospitals are funded by a prospective payment scheme based on Diagnosis Related Groups (DRG), two risks may arise whenever legitimate extra costs are not considered: patient selection and/or lower care quality. We aimed to analyse determinants of an increased length of stay (LOS) used as a proxy for costs, in major head and neck cancer surgery.

We selected all hospitalisations in France between 2015 and 2021 classified in the DRG « Major head and neck surgery », with a main diagnosis of cancer. We analysed determinants of the LOS using a multivariate linear model.

We analysed 19380 stays. We found several factors associated with increased LOS, that are not taken into account in the hospital funding scheme: complexity of surgical procedures, type of admission, patients' comorbidities.

Some of these factors should be considered in the hospital funding model.

The System Interventions to Achieve Early and Equitable Kidney Transplants Study (STEPS) is an ongoing pragmatic clinical trial investigating the effectiveness of an equitable and patient-centered approach to kidney care on equitable access to early kidney transplants for individuals with chronic kidney disease not on dialysis. The STEPS intervention combines active electronic health record surveillance to equitably identify all potentially eligible kidney transplant candidates in three health systems ('STEPS Surveillance') with a 'STEPS Outreach Program' (comprised of equity-conscious patient-centered transplant social worker and transplant coordinator outreach and navigation activities). Identified eligible participants are randomly assigned to receive either (a) Augmented Usual Kidney Care (routine care plus electronic surveillance and best practice alerts), or (b) the STEPS Health System Surveillance and Outreach Intervention plus Augmented Usual Kidney Care to improve access to kidney transplants overall as well as among Black and rural residing individuals. STEPS recruited all planned 1168 participants from March 2022 to March 2024. Outcomes will quantify differences between the study arms in progress toward and completion of kidney transplant evaluations, assessed via medical records, and patient-reported outcomes. Registration of clinical trials This study is registered at ClinicalTrials.gov under the identifier NCT05014256.

Background: Patients with severe and life-limiting illnesses transitioning out of the hospital often rely on family caregivers (FCGs) to manage communication with health care teams during hospitalizations and outpatient care. However, FCGs infrequently receive adequate training or support to prepare for these responsibilities. Effective communication between FCGs and health care teams is critical for preparing FCGs and reducing risks for poor outcomes. This study tested an eight-week intervention to improve FCG preparedness and communication practices during transitions out of the hospital. Methods: Conducted from 2018 to 2022, this randomized controlled trial included adult FCGs in rural areas in the United States (Minnesota, Wisconsin, and Iowa). FCGs caring for adults who received inpatient palliative care and were transitioning out of the hospital were eligible. The intervention group received teaching, guidance, and counseling from a palliative care nurse interventionist via video visits before and for eight weeks after discharge. The control group received monthly phone calls but no intervention. Outcomes included changes in FCG-reported preparedness for caregiving and communication with health care teams. Results: Of the 429 consented, 367 (183 intervention and 184 control participants) initiated the intervention; 164 had complete preparedness data, and 161 had complete communication data at baseline and eight weeks. In unadjusted analyses, the intervention group showed statistically significant improvements in preparedness but not communication practices. After adjusting for factors associated with care transitions, the findings persisted. Conclusion: Partnering rural FCGs with palliative care nurses via video can improve caregiver preparedness during care transitions. Improving communication practices may need more targeted strategies.

Lung ultrasound (LUS) has emerged as a simple, rapid, and non-invasive method for the dynamic assessment of pulmonary congestion, a major prognostic factor and a therapeutic target in acute heart failure (AHF). In a single-center prospective observational study, 42 patients hospitalized for AHF in the post-emergency polyvalent medicine department of CHU Grenoble were successively included between May 2021 and July 2022. Patients undergoing hemodialysis, those with pneumonectomy or lung fibrosis, or those placed under guardianship or deprived of freedom were excluded. Clinical examination, LUS, and electrolyte panel results were collected daily. Vital status was assessed 30 days after the last LUS. The primary endpoint was the evolution of the number of B-lines in relation to the dose of diuretic administered. Secondary endpoints included the evolution of B-lines according to clinical signs of congestion and plasma creatinine levels, the agreement between LUS and clinical findings at discharge, and the prognostic value of LUS at discharge for 30-day re-admission for AHF and all-cause mortality. A total of 188 LUS were performed. The patients were elderly (85.8 years [SD 8.1]) and comorbid. The median number of B-lines decreased from 17 at admission to 7 mid-hospitalization, then stabilized. The median daily intravenous diuretic dose declined from 40 mg to 20 mg. Patients with chronic kidney disease (CKD) had more B-lines at admission (24.2 (SD 11.6) vs. 8.2 (SD 8.8)). However, B-line evolution was independent of creatinine levels. Higher B-lines at discharge were significantly associated with 30-day mortality (15.2 vs. 3.9, p < 0.001). In the absence of a gold standard for the assessment of pulmonary congestion, LUS appears to be an additional tool for optimizing the management of AHF.

To validate the Hospital Frailty Risk Score (HFRS) in Chinese hospital settings, describing how patients are allocated to frailty risk groups and how frailty risk is associated with length of stay (LoS) and hospital costs.

Retrospective observational study.

Forty-eight hospitals in Lvliang City, Shanxi Province, China.

Patients aged 75 years or older hospitalised between 1 January 2022 and 31 December 2023 (n = 34,731).

A logistic regression model examined the association between long length of stay (LoS) and frailty risk. A generalised linear model assessed the association between hospital costs and frailty risk. Subgroup analyses of age group, sex, and hospital tiers were conducted.

22.2% of patients were categorised as having zero risk, 62.4% as low risk, 15.3% as intermediate risk, and 0.08% as high risk. Compared to the zero risk group: for those with low risk, the probability of long LoS was 1.92 (95% CI 1.79-2.06) times higher and hospital costs were ¥1926 (95% CI 1655-2197) higher; for those with intermediate risk, the probability of long LoS was 2.7 (95% CI 2.49-2.96) times higher and hospital costs were ¥4284 (95% CI 3916-4653) higher; and for those with high risk, the probability of long LoS was 6.7 (95% CI 3.06-14.43) times higher and hospital costs were ¥16,613 (95% CI 12,827-20,399) higher. The explanatory power of the HFRS held across subgroups.

Compared to patients aged 75 + elsewhere, those in China had lower frailty risk scores, likely reflecting a younger age structure and recording of fewer diagnosis codes. Even so, the HFRS is a powerful predictor of long length of stay and hospital costs in China.

Venous thromboembolism is a well-recognized complication after hepatopancreatobiliary surgery. However, there is a paucity of nationwide data on risk factors and incidence within 1 year of surgery in patients undergoing hepatopancreatobiliary surgery.

This nationwide observational population-based cohort study used data extracted from all patients undergoing surgery for cancer surgery of the liver and the pancreas in France between 1 January 2015 and 31 December 2017. Estimation of 1 postoperative year cumulative incidence of venous thromboembolism and Cox proportional hazards model on 1-year global mortality were performed.

During the study period, 16,960 patients underwent cancer surgery of the liver (n = 9,381) or pancreas (n = 7,579). The 90-day postoperative rate of venous thromboembolism was 6.1% (cancer surgery of the liver) and 6.7% (cancer surgery of the pancreas). Main risk factors of 90-day postoperative rate of venous thromboembolism were major hepatectomy (1.85; 1.55-2.21), left pancreatectomy (1.45; 1.18-1.79), presence of obesity (1.41; 1.16-1.71), history of venous thromboembolism (4.58; 3.41-6.14), open approach (1.31; 1.06-1.62), and the occurrence of serious surgical complication (1.55; 1.35-1.79). At 1 year, patients undergoing cancer surgery of the liver were at a lower risk of cumulative incidence (%) of venous thromboembolism compared with the cancer surgery of the pancreas group (P < .001) (7.0; 6.5-7.6 vs 9.8; 9.1-10.4). Patients with venous thromboembolism within 1 year had greater risks of 1-year global mortality for each hepatopancreatobiliary surgery group: 3.58 (95% confidence interval, 3.02-4.23) and 3.97 (95% confidence interval, 3.40-4.63), respectively.

Postoperative venous thromboembolism is a significant issue after hepatopancreatobiliary surgery, within 90 days postoperatively and up to 1 year, with the cancer surgery of the pancreas group being particularly at risk. A greater risk of global mortality within 1 year for patients experiencing early or late venous thromboembolism was found.

The aim of this study is to analyse the associations of annual Intrinsic Capacities (IC) impairment evolution with the annual cost of care in Nursing Home (NH) residents. This was a prospective, longitudinal and multicenter study. NH residents in the Occitanie region (south of France), 60 years and older with moderate level of dependency were included in the study and were followed during 12 months.

IC was assessed for four of the six IC domains (Cognitive, locomotion, vitality and psychological). Longitudinal IC impairment trajectories of residents were built using the K-means Longitudinal method. Costs were assessed from the healthcare payer's perspective and include direct medical and non-medical costs. Descriptive analyses of costs and characteristics as well as general linear models were carried out.

Three hundred forty-five residents (86 years old on average and mostly women) were included. Mild, moderate and severe impairment profiles were clustered. For the cognitive domain, we observe a total cost decrease of 1552€ between the most severe impairment profile and the less severe profile, led by medication costs. For the locomotion, psychological and vitality domains we observed a total cost increase of 1,672€, 3,869 € and 1,709€ for the most severe impairment profile in comparison with the less severe profile, respectively. This cost increase was driven by hospitalisation for the psychological and the vitality domains and by physiotherapist costs for the locomotion domain. Medication costs decrease with the severity of impairment whatever the IC domain considered.

Our study is the first aiming to estimate the association between impairment on IC domains and healthcare costs in NH. The implementation of clusterization highlight resident's profiles using data driven process, which may facilitate the implementation of personalized health strategies.

Background: This study explores the burden of Parkinson's disease (PD) in Kazakhstan, the largest country in Central Asia, a region where data on neurological disorders are notably sparse. Methods: Utilizing data from Kazakhstan's Unified National Electronic Health System during 2014-2021, the study investigates the epidemiology, disability-adjusted life years (DALYs), and survival outcomes in a cohort of PD patients. The authors employed Cox proportional hazards regression models and Kaplan-Meier analysis, alongside sensitivity analyses, to assess the impact of demographic factors, hypertension, and the Charlson Comorbidity Index (CCI) on survival. Results: The study cohort included 10,125 patients, revealing a tenfold increase in PD prevalence during the study period. Mortality rates varied significantly, with the highest rates observed in the eldest age group (137.05 per 1000 person-years). PD contributed to a loss of 156.12 DALYs per 100,000 population, primarily driven by years of life lost. The analysis identified an increased risk of all-cause mortality among males (adjusted hazard ratio (aHR) 1.6; 1.5-1.8), older individuals (aHR 1.05; 1.04-1.06), those with higher CCIs, and individuals of Kazakh ethnicity. Interestingly, patients with comorbid hypertension had a higher probability of survival (aHR 0.67; 0.60-0.73). Conclusion: This study is the first of its kind in Central Asia to examine the burden of PD using a large-scale outpatient registry. The findings underscore the need for targeted interventions to address the growing burden of PD, particularly among males and ethnic Kazakhs. Additionally, further research is needed to explore the inverse association between hypertension and survival in the PD cohort.

To analyze demographics, underlying diseases, and clinical outcomes of adult patients undergoing tracheostomy over 6 years, identifying annual changes and significant trends.

This study is a descriptive analysis of a retrospective cohort. Data were obtained from the Diagnosis Procedure Combination inpatient database in Japan between January 2016 and December 2021. Adult patients (≥ 20 years) who underwent tracheostomy were included, excluding those from facilities inconsistently included in the database. Trends in demographics, underlying diseases, Charlson Comorbidity Index scores, departments performing tracheostomies, intensive care unit (ICU) admissions, body mass index at admission, hospital stay duration, timing of mechanical ventilation initiation, and discharge routes were analyzed.

A total of 22,480 patients were included (66.0% men; median age, 73 years). Respiratory diseases (36.6%) were the most common condition, followed by neurological diseases (29.4%), cardiovascular diseases (21.2%), and cancer and benign tumors (19.9%). The median hospital stay was 56 days, which slightly decreased to 53 days in 2021. Transfers to other hospitals increased from 51.0% in 2016 to 55.9% in 2021. Among 10,499 patients requiring ICU ventilatory management, 2756 (26.3%) underwent tracheostomy within 7 days of initiating mechanical ventilation, with no significant increase in early tracheostomy rates over the study period.

The study highlights that respiratory diseases are the leading indication for tracheostomy in adults. The majority of tracheostomies were performed after the initiation of mechanical ventilation, underscoring prolonged ventilation as a primary indication. Further research is warranted to optimize guidelines for tracheostomy timing and indications in adult patients.

The natural history of multiple sclerosis (MS) is highly heterogeneous and almost unpredictable since several factors may affect the disease course including comorbidities. The aims of this study were to predict the risk of disability worsening and disease progression at the first patient's visit by using a modified version of the Charlson Comorbidity Index (mCCI).

the mCCI was obtained by incorporating the grade of pyramidal functional system scores extracted by the Expanded Disability Status Scale (EDSS) into the original CCI version. The risk of reaching EDSS 4, EDSS 6, and secondary MS progression (SPMS) associated to mCCI classes was calculated by carrying out multivariable Cox-regression models and it was reported as hazard ratios (HRs) and 95% confidence intervals (95% CIs). The accuracy of mCCI for the recognition of individuals who reached the study milestones was estimated by building the receiving operator curves and the optimal cut-off values were estimated.

A total of n = 622 individuals were enrolled (72.7% women; median age 30.8 years [24-40]). Compared with patients with a mCCI equal to zero, the HRs for those with a mCCI comprised between 1 and 2 at the first visit were 1.53 (1.1-2.1), 2.17 (1.48-2.96), and 1.57 (1.16-2.1) for the reaching of EDSS 4, EDSS 6, and SPMS, respectively. Moreover, individuals with a mCCI equal or higher than 3 were at even higher risk of reaching EDSS 6 (HR = 2.34 [1.44-3.8]) and SPMS conversion (HR = 2.38 [1.29-4.01]). The mCCI cut-off value of 3 reached a sensitivity and specificity of 88.1% and 77.8%, respectively, for the recognition of EDSS 4, while the mCCI cut-off of 4 reached a sensitivity of 83.1% and a specificity of 80.7% for the recognition of EDSS 6 and a sensitivity and a specificity of 76.8% and 87.5%, respectively, for the recognition of SPMS conversion.

mCCI appeared a simple and fast tool for the prediction of MS prognosis since the first patient's visit and its best cut-off values showed higher sensitivity and specificity for the recognition of patients who undergo disability worsening and SPMS conversion.

Background: This study compared the change in pre- and postoperative health-related quality of life (HRQoL) among breast cancer patients undergoing breast-conserving surgery (BCS), total mastectomy no reconstruction (TMNR), and total mastectomy immediate breast reconstruction (MIBR). Patient factors associated with postoperative anxiety and depression were also identified. Methods: This prospective cohort study enrolled breast cancer patients between September 2017 and August 2020. HRQoL changes from preoperative to six months postoperative were compared using patient-reported outcome tools assessing anxiety, depression, pain, perceived health, breast satisfaction, psychosocial, physical, and sexual well-being and analyzed with ANOVA and linear regression. Results: A total of 471 patients completed preoperative and postoperative surveys (BCS: 313, TMNR: 60, MIBR: 98). Postoperative anxiety decreased across all modalities, with MIBR showing the greatest reduction (p = 0.03), though still exhibiting the highest postoperative anxiety (p = 0.05). Depression and perceived health scores showed no significant difference in change across modalities (p = 0.15, p = 0.48). MIBR patients showed the greatest increase in pain (p = 0.05) and the highest postoperative pain scores (p = 0.04). All three modalities showed a clinically significant decline in physical and sexual well-being. TMNR and MIBR had additional reductions in breast satisfaction, with TMNR also showing a decline in psychosocial well-being. Absolute postoperative scores for breast satisfaction, psychosocial, physical, and sexual well-being remained highest in BCS compared to TMNR and MIBR (p < 0.01, for each domain). In multivariable regression analysis, postoperative depression and anxiety scores did not differ between surgical modalities, but younger age was significantly associated with higher postoperative depression, pain and anxiety (p < 0.01), and adjuvant chemotherapy with higher postoperative depression (p < 0.01). Conclusions: BCS may have better overall HRQoL outcomes, specifically in breast satisfaction, psychosocial, physical, and sexual well-being, compared to TMNR and MIBR. Additionally, younger age, rather than surgical modality, was found to be associated with higher postoperative depression, pain, and anxiety scores.

To determine prognostic factors of disability in multiple sclerosis (MS), that is, (1) identify determinants of the dynamics of disability progression; (2) study the effectiveness of disease-modifying treatments (DMTs); (3) merge determinants and DMTs for creating patient-centred prognostic tools and (4) conduct an economic analysis.

Individuals registered in the French Observatoire Français de la Sclérose en Plaques (OFSEP) database were included in this OFSEP-high definition cohort if they had a diagnosis of MS, were ≥15 years old and had an Expanded Disability Status Scale (EDSS) score <7. The outcomes will be assessed annually: (1) time to reach irreversible EDSS scores of 4, 6 and 7; (2) relapses and disease progression; (3) MRI-based progression, patient-reported outcomes, social consequences; and (4) combined outcomes on activity and progression. Clinical and quality-of-life data, MRI results and biological (blood, serum) samples will be collected at each follow-up.

A cohort of 2842 individuals, 73.4% women, mean (SD) age of 42.7 (11.6) years, median disease duration of 8.8 years, has been recruited from July 2018 to September 2020. The course of MS was relapsing remitting in 67.7%, secondary progressive in 11.9%. The mean annual relapse rate was 0.98. The disease-modifying treatment received was highly effective therapy in 50.3% and moderately effective therapy in 30.7%.

The participants will be followed until December 2026. Disease course up to four landmarks will be examined as predictors of disease progression: (1) diagnosis of MS; (2) relapse activity worsening and independent progression; (3) any recent disease activity and (4) any visit with absence of disease activity in the past 5 years. The marginal effectiveness and tolerability of treatments will be assessed. Stratified algorithms will be proposed for medical decision-making. Economic evaluation of disease cost and cost-effectiveness of new DMTs will be conducted from a public payer perspective.

NCT03603457.

To estimate the excess formal social costs or direct non-healthcare costs of dementia-related neuropsychiatric symptoms (NPS).

The presence of dementia, NPS, antipsychotic and antidepressant use, somatic and psychiatric comorbidities, and formal social benefits were studied in a regionwide cohort of all 60-year-old and older individuals. A random forest-based algorithm identified NPS, and 2-part regression models and entropy balance were used.

Of the 215 859 individuals, 7553 (3.50%) had dementia, 74 845 (34.7%) had some NPS, and 20 787 (9.63%) received long-term care benefits. Notably, nearly two-thirds (63.9%) of people with dementia received benefits. The probability of having social costs varied markedly with age (odds ratio [OR] 12.28 [10.17-14.82] for >90-year-olds category), and the presence of dementia (OR 7.36 [6.13-8.84]) or NPS (OR 3.23 [2.69-3.88]). NPS (relative change [RC] 1.39 [1.31-1.49]) and dementia (RC 1.32 [1.24-1.41]) were associated with higher average benefit costs. Low socioeconomic status was significantly associated with both a higher probability of receiving benefits (OR 1.52 [1.38-1.68]) and higher costs of their provision (RC 1.18 [1.15-1.21]).

The burden of caring for NPS is greater than that indicated by the literature as these symptoms multiply the social costs of dementia by more than 3, owing to the greater use of residential care and formal coverage reaching more patients than that indicated by the literature. The greater presence of dementia and NPS in the population of lower socioeconomic status indicates an inequality in health attenuated by greater use of social benefits.

Health disparities along the rural-urban spectrum are a growing concern. The objective of this study was to determine whether in France, clinical profile, care and outcome after ischemic stroke differed between patients affiliated to the statutory health insurance system dedicated to the agricultural economic sector (i.e., Mutualité Sociale Agricole [MSA]) and all other patients.

Data on all patients aged≥20 years hospitalized for ischemic stroke in mainland France in 2018 were extracted from the French National Health Insurance Data System. Age-standardized percentages were used to compare the care accessed by MSA versus other stroke patients. Associations between health insurance scheme and case fatality were assessed using Poisson regression.

Of 87,864 stroke cases 7928 (9%) were MSA patients. MSA patients were more often rural dwellers (75.4 versus 32%) and older (median age: 84 versus 76 years). In the 12 months prior to the stroke, access to general practitioner (GP) was similar, but MSA patients were less likely to have an appointment with a cardiologist. Pre-stroke drug prescriptions suggested a better cardiovascular profile in male MSA patients (e.g., antidiabetics: 18.1 versus 21.5%). A part from a lower access to stroke unit (e.g., women: 55.3 versus 59%) other acute care indicators, including reperfusion therapy, were comparable. The crude 7-day case fatality was higher for MSA patients (Relative Risk [RR]: 1.44, 95% CI [1.32-1.57]), but this disadvantage reduced to non-significant level after adjustment for age, comorbidities and stroke management (adjusted RR: 1.07 95% CI [0.98-1.18]) CONCLUSIONS: For the mostly farming, rural, MSA population, pre-stroke, acute and post-stroke care did not differ markedly from that provided to other patients. The lower density of GP in rural areas and the remoteness from specialized center did not result in less access to preventive and acute stroke care for MSA patients in 2018.

Lenvatinib plus pembrolizumab has demonstrated improved survival compared with doxorubicin or paclitaxel monotherapy in patients with advanced or recurrent endometrial cancers (ECs). However, response rates to monotherapy are poor in recurrent settings. Herein, we performed a retrospective analysis using real-world data to compare the outcomes of lenvatinib plus pembrolizumab, carboplatin plus paclitaxel (PT), and doxorubicin for patients with PT-pretreated, advanced, or recurrent ECs.

We performed a multi-institutional retrospective analysis using de-identified electronic health record database (TriNetX) to compare lenvatinib plus pembrolizumab, carboplatin plus paclitaxel (PT), and doxorubicin outcomes in patients with PT-pretreated, advanced, or recurrent ECs. A 1:1 propensity score matching (PSM) was conducted. The primary outcome was the overall survival (OS) among treatment groups. The secondary outcome was the adverse event profile.

Between January 2012 and September 2023, we identified 397 patients with PT-treated, advanced, or recurrent ECs who received lenvatinib plus pembrolizumab, and 469 patients receiving PT at a platinum-free interval of over 6 months. Following PSM, no significant difference in median OS was observed between the lenvatinib plus pembrolizumab and re-challenge PT groups (19.1 vs. 18.5 months, p = 0.60; hazard ratio: 1.08, 95% confidence interval 0.81-1.46). However, lenvatinib plus pembrolizumab provided better survival benefits than doxorubicin. Adverse event analysis showed more hypothyroidism, hypertension, and proteinuria with lenvatinib plus pembrolizumab, and more hematologic toxicities in both chemotherapy groups.

Lenvatinib plus pembrolizumab was not associated with improved survival when compared with re-challenge PT in patients with a platinum-free interval of over 6 months. Re-challenge PT remains a valid option for PT-treated, recurrent, or advanced ECs, especially in patients with a substantially long platinum-free interval.

In response to the rapid global transmission of COVID-19, governments worldwide enacted lockdowns and other non-pharmaceutical interventions (NPI) to control the disease. In this study, we aim to quantify the influence of NPIs on the transmission of COVID-19 within selected European regions, specifically Spain (including the Basque Country) and Italy (including Tuscany), during the period of February to December 2020, which predates the initiation of COVID-19 vaccinations. We investigate potential correlations and associations between the implementation of NPIs, changes in COVID-19 transmission rates, and alterations in life expectancy across different age and sex categories from the year 2019 to 2020.

We use a Susceptible-Hospitalized-Asymptomatic/Mild-Recovered-Deceased (SHARD) ordinary differential equations model to analyze COVID-19 dynamics in the studied regions. The model calibration process was performed with empirical data on hospitalization and death to estimate the weekly transmission and death rates. To quantify reductions in life expectancy, we used established survival analysis techniques.

The SHARD model effectively captures multiple waves of COVID-19, accurately representing peaks and aligning with the instantaneous reproduction number. Our analysis reveals a 66-78% reduction in transmission rates during the initial set of NPIs in March 2020, followed by a 34-55% reduction during the subsequent NPIs in October 2020. Additionally, the elderly and individuals with comorbidities experienced the most pronounced reductions in life expectancy.

Our model calibration approach provides a valuable tool for evaluating the effectiveness of interventions across multiple waves of an epidemic. By applying this method to COVID-19 dynamics, we have demonstrated the capacity to quantify the impact of non-pharmaceutical interventions (NPIs) on transmission rates. These findings offer practical insights into the effectiveness of NPIs in mitigating COVID-19 spread and contribute to the broader understanding of epidemic control strategies.

Describe real-world epidemiology, treatment patterns, health care resource utilization, and costs of locally advanced or metastatic urothelial carcinoma (la/mUC) in France.

Retrospective study including all adults with la/mUC diagnosis during January 2017 to December 2020 in the PMSI database.

Annual prevalence and incidence ranged from 36.4 to 38.9 and 16.4 to 18.5 cases per 100,000 people, respectively. Of the 25,314 patients with incident la/mUC, 37.6% did not receive first-line systemic treatment. Of the 14,656 patients who started first-line systemic treatment, 66.6%, 22.5%, and 10.9% received 1, 2, and 3 lines of therapy, respectively. Annual per-patient costs in second-/third-line setting ranged from €8803 to €16,012.

The substantial disease burden of la/mUC in France highlights the unmet need for new therapies.

This paper investigates the effects of health-care spending on mortality rates of patients who experienced a heart attack. We relate in-hospital deaths to in-hospital spending and post-discharge deaths to post-discharge health-care spending. In our analysis, we use detailed administrative data on individual personal characteristics including comorbidities, information about the type of medical treatment and information about health-care expenses at the regional level. To account for potential selectivity in the region of health-care treatment we compare local patients with visitors and stayers with recent movers from a different region. We find that in regions with higher health-care spending mortality after heart attacks is substantially lower. From this we conclude that there are long-term returns to local health-care spending.

For older adults, spending time out of bed is important for preventing functional decline, but its relationship to mortality is not clear. In this study, we aimed to investigate the association between mortality and time spent out of bed in Japanese older-adult nursing home residents.

We conducted a cohort study using data from the Long-term Care Information System for Evidence database.

We used data collected between April 2022 and March 2024 from older-adult nursing home residents who required assistance with the activities of daily living.

We compared outcome data between residents who spent 6 or more hours per day out of bed (group L) and those who spent less than 6 hours per day out of bed (group S). The outcome was all-cause mortality. Data were analyzed using Kaplan-Meier curves and Cox regression models.

Data from 185 older-adult nursing home residents (median age: 89 years; 141 women) were analyzed. Group L included 144 residents (77.8% of all participants). Of the 185 participants, 40 died during the observation period. Mortality in group L was significantly lower than in group S (16.7% vs 39.0%, P = .002). Kaplan-Meier curve analysis after the log-rank test revealed a significantly higher mortality in group S than group L. Univariate and multivariate Cox regression analyses with robust (Huber-White) standard errors identified the factor of time spent out of bed (≥6 h) as a significant and independent risk factor for mortality.

More time spent out of bed is associated with lower mortality in older-adult nursing home residents who require assistance with the activities of daily living.

We aimed to describe the medications prescribed to people aged ≥90 years.

A cohort study was performed using data from the year 2022.

Using data from the French National Health Data System, people aged ≥90 years affiliated with the general insurance scheme were included.

Medications dispensed, polypharmacy (≥5 drugs), and hyperpolypharmacy (≥10 drugs) were described in the total population and according to sex, age group (90-94 years, 95-99 years, ≥100 years), and place of residence. All analyses were conducted by quarter because of the high mortality rate in this population.

In total, 696,498 subjects were included in the study. Among them, 73.2% were women, 75.9% were aged 90-94 years, and 2.9% were ≥100 years. Treatment for hypertension was prescribed to 77%, 50.4% had cardiovascular disease, and 17.7% had dementia. During the first quarter, 77.7% experienced polypharmacy. The most prescribed drugs were antihypertensive medications (73.8%), analgesics (58.8%), antithrombotics (55.3%), vitamin D (51.1%), and psychotropics (42%). There was a decrease in preventive drugs and an increase in symptom management drugs with increasing age. Subjects in nursing homes were more likely to take psychotropics and less likely to receive cardiovascular drugs. The results for the other quarters were similar.

Our results suggest a progressive, but probably insufficient decrease in the prescription of certain medications with age and to a lesser extent, in nursing homes. The discontinuation of treatments should be discussed in the context of short life expectancy to avoid the harmful effects of polypharmacy.

The out-of-hospital care pathways of people with DFU have been little studied. We used the French National Health Data System (SNDS) to collect refund and care pathway data for all French residents. The aim of this study was to determine the incidence of major lower limb amputation (MA) and associated risk factors in a population with an incident DFU.

We included any person living with diabetes and incident DFU. The primary endpoint was the occurrence of MA within one year. We considered the course and consumption of care one year before and one year after the initial event.

In 2018, 133,791 people were included, and during the follow-up, MA was performed in 4,733 (3.5 %). Among these people with MAs, 16.4 % were included via the out-of-hospital part of the protocol, and their first contact with the hospital led to MA. Factors associated (hazard ratio, HR [95 % confidence interval, CI]) with MA were: being male (1.92 [1.78;2.08]), arteriopathy of the lower limb (10.16 [9.36;11.03]), psychiatric disease (1.10 [1.01;1.20]) and end-stage renal disease (2.12 [1.93;2.33]). Regarding the care pathway, associations (HR [95 %CI]) were observed between lower MA rates and people with more general practitioner (0.83 [0.75-0.91]), private nurse (0.88 [0.81-0.95]) and diabetologist (0.88 [0.81-0.95]) visits. Living in the most disadvantaged municipalities was associated (HR [95 %CI]) with a higher MA rate (1.17[1.06-1.29]).

This is the first national study of the care pathways followed by people with DFU. Failures in the care pathway, precariousness and several comorbidities were identified, with an impact on the MA risk.

This study aimed to construct a nomogram predicting oral frailty risk in Older adults patients with stroke.

A cross-sectional study.

We selected 664 hospitalised older adults patients with stroke in a tertiary hospital from January 2023 to March 2024. Among them, 451 cases from January to December 2023 formed the modelling group, and 213 cases from January to March 2024 served as the validation group. Univariate and multivariate logistic regression analyses identified independent risk factors for oral frailty. A nomogram was developed and visualised using columnar charts. The model's predictive performance was assessed using the receiver operating characteristic curve and the Hosmer-Lemeshow test.

The prevalence of oral frailty was 47.7% in the modelling group and 47.9% in the validation groups, respectively. Age (OR = 10.351), frailty (OR = 9.171), number of comorbidities (OR = 11.301), nutritional risk (OR = 17.419), NIHSS (OR = 13.234), oral health evaluation index (OR = 0.316), Barthel index (OR = 0.247) were identified as significant independent risk factors. The areas under the receiver operating characteristic curve for the modelling and validation groups were 0.945 and 0.915, respectively.

A high prevalence of oral frailty was observed among Older adults patients with stroke with diverse risk factors. The nomogram provides an effective screening tool for identifying patients at high risk of oral frailty early in their hospital stay. The risk-prediction model showed good predictive efficacy and clinical utility.This study introduces a nomogram to predict oral frailty and identify associated risk factors in Older adults patients with stroke early on. It supports personalised care and precision medicine approaches in clinical practice.

There is evidence on the efficiency of new direct oral anticoagulants (DOAC), mostly based on experimental efficacy data, but there is also a need to assess their cost-effectiveness in routine clinical practice using patient-level data. We designed a retrospective cohort study to assess the cost-effectiveness of DOAC compared to acenocoumarol in patients with non-valvular atrial fibrillation (NVAF) with a follow-up of up to 7 years.

Basque Health Service-registered patients who started oral anticoagulant treatment between 2013 and 2016 were included in the study and followed up until the end of 2019. Data were extracted from an electronic medical record management system. Effectiveness was expressed in terms of life years gained and adjusted for health-related quality of life (i.e., quality-adjusted life years [QALY]). Propensity score techniques were used to adjust the estimates for differences between groups in baseline characteristics.

A total of 10,843 new users of oral anticoagulants with a mean follow-up of 4.1 years were included. The incremental cost-effectiveness ratio of DOAC compared to acenocoumarol ranged from €1,732 to €2,556/QALY, while the incremental net benefit for different willingness-to-pay thresholds was only negative for values below €3,000/QALY.

Based on the analysis of data from clinical practice and the similarity of results using several different techniques to adjust for bias associated with observational studies, we conclude that DOAC would be an efficient alternative for the treatment of patients with NVAF.

Oral glucocorticoids (OCS) remain one of the most important treatments for SLE but are associated with damage. Evidence regarding the real-world use of OCS in nationwide SLE populations is currently lacking. The aim of this study was to analyse OCS use and SLE treatments in French patients with SLE at the national level.

The nationwide French health insurance claims database, which contains pseudonymised data for ≈66 million people, was used. Prevalent patients with SLE (International Classification of Diseases, 10th Revision code M32, recorded as a chronic condition or associated with hospital stay) were identified over the year 2019. SLE treatments were captured through actual drug deliveries by pharmacies and mean daily OCS doses (prednisone equivalent) were calculated for the year 2019.

The 2019 French prevalent SLE population comprised 31 852 patients (86.3% of women, with a mean age of 49.7 (±15.9) years) with a mean disease duration of 7.1 (±6.2) years. Among these, 48.3% were treated with OCS. The mean daily OCS dose was ≤5 mg/day in 35.9%, more than 5 mg but <7.5 mg/day in 6.4% and ≥7.5 mg/day in 6.0%. The use of other SLE treatments was significantly increased in patients with higher doses of OCS (p<0.0001). Potential complications of OCS, including cardiovascular diseases, infections and osteoporosis, were significantly increased in patients with SLE receiving more than 5 mg of OCS per day (p<0.0001, for all). Strikingly, 13.6% of patients receiving mean daily OCS doses >5 mg/day were not treated with antimalarial, immunosuppressant or biologic drugs for SLE.

In total, 48.2% of French patients with SLE were treated with OCS in 2019, including 12.4% at a mean dose >5 mg/day, with an increased risk of OCS complications and a limited use of antimalarials, immunosuppressants or biologics. These results highlight the urgent need for the implementation of more robust OCS-sparing strategies in SLE.

In January 2021, the United States (US) Food and Drug Administration (FDA) approved the first long-acting injectable antiretroviral therapy (LAI ART) regimen for the treatment of HIV providing an alternative to daily oral regimens. We analyzed electronic health records (EHRs) to provide real-world evidence of demographic and clinical characteristics associated with the receipt of LAI ART among people with HIV (PWH).

Leveraging EHRs from a large clinical research network in the Southern US - OneFlorida + linked with Medicaid (updated to 08/2022) - we identified a cohort of PWH who have been prescribed at least one dose of LAI ART since January 2021 and characterized their demographics, clinical characteristics, and HIV care outcomes.

A total of 233 LAI ART recipients were identified: 56.7% female, 45.1% aged 30 to 44, 51.3% non-Hispanic Black, 78.1% on Medicaid and 4.7% on private insurance. Approximately three-quarters of injections (71.2%) were received within 37 days of the previous dose, and 84.4% were received within 67 days. About 8% of LAI ART recipients did not have optimal care engagement the year before LAI ART initiation; one in five recipients had a diagnosis of alcohol or substance use disorder in lifetime. All achieved viral suppression (< 50 copies/mL) before starting LAI ART. Of a subset of patients with HIV viral load test records, only 1 record of virologic failure (viral load > 200 copies/ml) was observed after the initiation of LAI ART.

There has been an increasing trend of LAI ART initiation since approval. People with suboptimal care engagement and with substance use disorder in lifetime were not excluded from LAI ART treatment.

Previous studies have shown that people with multiple sclerosis (MS) had frequent healthcare visits up to 10 years before being diagnosed but with no information from magnetic resonance imaging (MRI) scans of the connection with the radiologically isolated syndrome (RIS).

To analyze healthcare use 3 years before the RIS diagnosis.

We examined healthcare usage before the first scan in RIS cases from 2010 to 2019. RIS subjects were identified from the French National MS observatory and compared to the general population (matched 10:1) and MS patients (matched 4:1).

Among 482 RIS individuals, 223 (46.3%) were not linked to the healthcare resources database. The remaining RIS individuals (53.7%) had higher healthcare usage before their RIS diagnosis for issues related to neurology visits, headaches (odds ratio (OR): 3.34, confidence interval (CI): [2.00-5.57], p < 0.0001), and the use of anti-migraine drugs (OR: 2.61, CI: [1.37-4.99], p = 0.004) compared to MS.

Only about half of RIS patients had MS-selected healthcare resources, which allowed for data linkage. Those who did seek care before their RIS diagnosis were most commonly known for other neurological comorbidities. These findings do not support the idea of a systemic prodrome before RIS diagnosis.

The study aims to investigate the key risk factors influencing the prognosis of patients with severe fever with thrombocytopenia syndrome (SFTS) and develop a prognostic warning model based on these factors. A total of 264 SFTS patients treated at Tongji Hospital from April 1, 2023, to July 30, 2024, were included as the research sample. Retrospective analysis was conducted based on the final prognostic status of the patients, dividing them into a survival group (n = 165) and a death group (n = 99). Univariate and multivariate analyses were performed along with LASSO and logistic regression on baseline information and the first laboratory indicators within 24 h after admission to identify independent risk factors affecting prognosis. A warning model was constructed based on these factors. The analysis revealed that age (OR = 1.098, 95% CI: 1.054-1.149, p < 0.001), presence of consciousness disorders (OR = 2.506, 95% CI: 1.042-6.187, p = 0.042), BUN (OR = 1.248, 95% CI: 1.154-1.369, p < 0.001), and viral load (OR = 3.598, 95% CI: 2.572-5.288, p < 0.001) were identified as independent risk factors significantly impacting the prognosis of SFTS patients. A nomogram warning model was developed incorporating these four risk factors, which demonstrated excellent predictive performance (ROC = 0.917, 95% CI: 0.882-0.948, p < 0.001). The prognostic risk prediction model successfully established for SFTS patients in this study exhibits robust predictive performance, and it is anticipated to serve as a practical clinical tool for predicting disease progression and prognosis in SFTS patients.

We aimed to investigate the impact of enterococci on initial antibiotic treatment (IAT) failure and prolonged hospitalization in complicated urinary tract infection (cUTI) cases, and to identify risk factors for enterococcal cUTI.

Adult cUTI patients were analyzed to compare the differences between the Enterococcus and non-Enterococcus groups. Univariate and multivariate analyses were employed to identify independent risk factors.

This study included 419 patients, with the Enterococcus group showing significantly higher IAT failure rates and an extended average length of stay by 4.4 days compared to the non-Enterococcus group. Multivariate analysis identified enterococci, hospital-acquired UTIs (HA-UTI), indwelling catheters, and bed rest (bedridden) as independent risk factors for IAT failure. Enterococci were notably linked to prolonged hospitalization, other independent risk factors included IAT failure, prior antimicrobial use, age-adjusted Charlson comorbidity index (ACCI) ≥ 4, hypoalbuminemia, and bed rest. Urological cancer, HA-UTI, indwelling catheters, urinary retention, and urologic surgery were risk factors for enterococcal cUTI.

We provide the first evidence that enterococci independently increase the risk for IAT failure and prolonged hospitalization in adults with cUTIs, highlighting the significance of timely identification to optimize measures including antibiotic regimens. Risk factors for enterococcal cUTI have also been identified to aid clinicians in managing this condition.

Little is known about postdischarge healthcare resource use (HCU) among patients hospitalized for coronavirus disease 2019 (COVID-19). The objective was to identify distinct profiles of patients based on postdischarge cares.

This was a retrospective cohort study using the French National Health System claims database. We followed up all patients hospitalized for COVID-19 between 2020/02/01 and 2020/06/30 for 6 months; the discharge date was the index date. We excluded patients who died during the index stay or within 30 days after discharge. We described patients' HCU over 5 months from day 31 after the index date to the end of follow-up, i.e., the post-COVID-19 period. We described the sociodemographic and clinical characteristics of the participants and 44 selected types of HCU, including medical and emergency room visits, medications, medical and biological tests, oxygen therapy, rehabilitation, rehospitalization, nurse visits, and sick leave. We performed Ward's ascendant hierarchical clustering (AHC) analysis to identify groups of patients with similar post-COVID-19 HCU and described HCU and clinical characteristics by cluster.

The study population included 68,822 patients (median age: 64.8 years, 47% women). Eight clusters of patients were identified, each comprising between 1,163 and 35,501 patients. Four clusters were characterized by older patients and high proportions of comorbidities, i.e. cancer (cluster 3), mental disorders (cluster 4), cardiac insufficiency (cluster 5) and respiratory failure (cluster 6). Cluster 8 was characterized by younger patients, often obese and with low mortality. Another cluster was characterized by complex index stays (cluster 7) and a last cluster (cluster 2) by specific medical contacts and therapy. The main cluster (cluster 1, n = 35,501) was similar to the overall study population. The duration and complexity of the index stay also varied across clusters.

Based on HCU data, AHC identified 8 clinically relevant profiles of patients surviving the acute episode of COVID-19 hospitalization. The clusters illustrate the many impacts of COVID on the health status of infected patients and may help anticipate future needs of care in a similar context.

Carbon monoxide poisoning can cause migraine-like attacks. However, the association between carbon monoxide poisoning and the risk of migraine has not been thoroughly studied. This study aimed to investigate the long-term risk of migraine in patients with carbon monoxide poisoning.

This nationwide, population-based cohort study was conducted using the administrative database of the National Health Insurance Service of Korea from 2002 to 2021. Patients with carbon monoxide poisoning with at least one visit documented according to the International Classification of Diseases, 10th Revision code T58 were included. Patients were only included if they had the same diagnostic code at two or more outpatient clinic visits. The primary outcome of this study was the incidence of migraine after carbon monoxide poisoning.

The overall risk of migraine was higher in the carbon monoxide poisoning group regardless of age, sex, or use of hyperbaric oxygen therapy (adjusted hazard ratio, 1.37; 95% confidence interval, 1.28-1.48). The carbon monoxide poisoning group had a persistently higher cumulative incidence of migraine during the observation period than the control group.

Carbon monoxide poisoning was associated with an increased overall risk of developing migraine during long-term follow-up.

Autoimmune hemolytic anemia (AIHA) is a rare and sometimes life-threatening disease. Infections are frequent and often severe during the course of AIHA. Rituximab is commonly used to treat patients with AIHA. This study aimed to assess the risk of hospitalization with infection after rituximab in patients with primary AIHA. We selected all adult patients newly diagnosed for primary AIHA and treated with rituximab between 2012 and 2018 in the French national health database. Patients were considered exposed to rituximab within 6 months after the first infusion. The main outcome was hospitalization with infection, identified by a discharge diagnosis of infection during the rituximab exposure. The cohort consisted of 959 patients (mean age of 67 years, standard deviation of 17.8 years; 60.5% of women). The 6-month cumulative incidence of hospitalization with infection was 17.6% (95% confidence interval [CI], 15.2-20.0). The most frequently characterized infections were pulmonary (40.2%). Opportunistic infections were observed in 28 (16.6%) patients, including 11 cases of pneumocystosis. All cases of pneumocystosis occurred in patients concomitantly exposed to corticosteroids, none of them had prophylaxis and all but 2 were aged ≥70 years. Overall, the main factors associated with hospitalization with infection were an age ≥70 years and the exposure to corticosteroids. The 30-day overall mortality after hospitalization with infection was 12.5% (95% CI, 8.0-18.0). In conclusion, the incidence of hospitalizations with infection, including opportunistic infections, as well as the subsequent mortality, are high in adult patients with primary AIHA treated with rituximab. Pneumocystosis prophylaxis should be encouraged in older patients exposed to corticosteroids.

Several cardiovascular outcome trials have been conducted to assess the cardiovascular safety and efficacy of glucagon-like peptide-1 receptor agonists (GLP1-RAs) on cardiorenal outcomes in patients with type-2 diabetes (T2D). However, the strict requirements of randomised controlled trials to avoid most confounding factors are at the expense of external validity. Using national real-world data, we aimed to evaluate the effectiveness of GLP-1RAs in association with metformin especially on cardiovascular events, hospitalisation for heart failure and all-cause death in comparison with other diabetes treatment schemes using dipeptidyl peptidase IV inhibitors, sulfonylureas/glinides or insulin also associated with metformin. Sodium-glucose transport protein 2 inhibitors (SGLT-2i) will be excluded as comparators, as this class of oral hypoglycaemic agents just started in 2020 to be marketed in France.

The Système National des Données de Santé is a comprehensive nationwide administrative healthcare database in France that covers approximately 67 million people.Several cohorts of adult patients with T2D initiating any GLP1-RA in dual or triple therapies, as recommended by the French Health authorities, will be identified in this database over the period 2016-2021. These cohorts will be defined by the combination of glucose-lowering drugs prescribed simultaneously with GLP1-RA and diabetes treatment received over a 6-month period before GLP1-RA initiation. They will be first matched with T2D controls (1:3 ratio) based on the year of drug initiation and treatment regimens before and simultaneously with GLP1-RA in the different selected cohorts. Comparative analyses will be conducted versus these control groups, adjusting for cardiovascular event history and a propensity score considering age, sex, area of residence, deprivation index, comorbidities, duration of diabetes, use of lipid-lowering drugs, anticoagulants, antiplatelet therapies and blood pressure-lowering therapies. Comparative analyses will be conducted versus these control groups, using a high-dimensional propensity scores method and fixed baseline characteristics. Treatment effects on the different outcomes measured will be estimated for each GLP1-RA group, through HR and their corresponding CIs (95% CI) using Cox regressions and/or competitive risk regressions when necessary.

The study has been approved by an independent ethics committee (Comité éthique et scientifique pour les recherches, les études et les évaluations dans le domaine de la santé, Paris, France; reference: 8699786, dated 2 June 2022) and has been registered with the French National Data Protection Commission (Commission Nationale de l'Informatique et des Libertés, Paris, France; reference: 922161, dated 26 June 2022). The findings of this study will be published in peer-reviewed scientific journals and presented at international conferences.

F20220803152803.

Few data are available on the course of myasthenia gravis (MG) regarding disease severity and stability over time in real-world settings. This study used the French National Health Insurance Database (SNDS) to assess markers of disease severity in patients with MG longitudinally.

All patients with MG-related claims in the SNDS between 2013 and 2020 were identified. Patients were followed for up to 8 years after the first claim. Intensive care unit (ICU) stays, treatment with intravenous immunoglobulin (IVIg) or plasma exchange (PE), and death were documented throughout the follow-up period. Standardized mortality rates were estimated, and mortality-related variables were identified using a Cox model.

In all, 14,459 individuals constituted the full study population, including 6354 incident patients. In the incident population, 2199 (34.6%) were admitted to ICUs at least once, principally during the first year after the index date (N = 1477; 23.3%). This proportion decreased progressively to reach 3.0% in the seventh year. A total of 2817 patients received IVIg and 432 PE, again principally in the first year. In the full study population, the standardized mortality rate was 1.08 (95% confidence interval [CI] 1.03-1.13), being lower in men (0.95, 95% CI 0.89-1.02) than in women (1.15, 95% CI 1.07-1.23) and in patients aged >65 years (1.06, 95% CI 1.01-1.11) than in younger patients (1.50, 95% CI 1.24-1.76). Male gender, older age and higher comorbidity were independently associated with mortality.

A subgroup of patients with MG require ICU admission and rescue therapy with IVIg or PE, indicative of poor disease control. New therapies are needed to improve disease control and reduce disease burden.

Rates of venous thromboembolism (VTE) recurrence and bleeding remain high in patients with cancer who are prescribed anticoagulants (ACs) such as low-molecular-weight heparin (LMWH) after an initial VTE event.

To identify patient characteristics associated with VTE recurrence and bleeding in patients receiving LMWH for cancer-associated VTE and to explore secondary AC management and clinical outcomes in these patients.

An observational study was conducted using nationwide French data for adults with active cancer who were hospitalized with VTE in 2013-2018 and were reimbursed for LMWH ≤ 30 days after hospital discharge. The main outcomes were VTE recurrence and bleeding. For both outcomes, the proportions of patients who experienced the outcome were calculated for different patient characteristics. AC switching following VTE recurrence and bleeding was tracked using Anatomical Therapeutic Chemical codes.

A total of 31,771 patients received LMWH, of whom 1925 (6.1%) experienced VTE recurrence and 1804 (5.7%) bleeding. Most recurrent VTE and bleeding events occurred within 6 months after the initial VTE event. The proportion of patients with VTE recurrence and bleeding varied between cancer types. Most patients who experienced VTE recurrence or bleeding continued to receive LMWH. Eleven percent of patients with VTE recurrence experienced a further recurrent VTE event within 3 months.

More than 10% of patients who received LMWH for cancer-associated VTE experienced VTE recurrence or bleeding. AC management options in this patient population should be prospectively assessed in clinical trials.