Acute lymphoblastic leukemia (ALL) is the most common pediatric cancer. Vincristine is a core chemotherapeutic agent for patients with ALL; unfortunately, approximately 78% will develop vincristine-induced peripheral neuropathy (VIPN). VIPN can result in vincristine dose reductions that decrease therapeutic efficacy: making it important to understand which children are at highest risk for VIPN. We hypothesized that pediatric ALL patients who were obese at diagnosis would develop worse VIPN than healthy weight children with ALL within the first year. Our results confirmed that obese pediatric patients have significantly (p=0.03) worse VIPN than patients of healthy weight.
INTRODUCTION: Delirium is a postoperative neurologic morbidity in glioblastoma whose risk factors, incidence, and prognostic implications remain undefined. We developed an algorithm using preoperative factors to predict postoperative delirium. METHODS: Retrospective analysis of 554 consecutive patients (mean age=61.5 years; 42% female) undergoing first glioblastoma procedure at our institution 2005-2011. RESULTS: Postoperative delirium occurred in 7% of patients (n=37). Patients undergoing biopsy (10%;n=54) did not experience delirium. In patients undergoing resection (n=500), multivariate logistic regression identified four factors independently predicting postoperative delirium: age (>70 vs. 50-70 vs. <50 years) (13% vs. 7% vs. 3%;OR=2.2 [1.2-4.1]), bihemispheric tumors (13% vs. 6%;OR=2.4 [1.4-5.0]), tumor size (>4.5cm vs. 3-4.5cm vs. <3cm) (12% vs. 7% vs. 0%;OR=2.6 [0.8-5.0]), and chronic pulmonary disease (26% vs. 7%;OR=3.5 [1.3-9.8]). We developed a score function entitled "GRAD" (Glioblastoma-Risk-Assesment-for-Delirium) to stratify patients into risk categories using the relative magnitudes of regression coefficients of preoperative factors, assigning 1 point for "bihemispheric tumor", age 50-70y, or tumor size=3-4.5cm and two points for chronic pulmonary disease, age >75y, or tumor size >4.5cm. Point totals were summed: patients with 0-1 (n=63), 2-3 (n=275), and 4-7 (n=91) points were designated as low-, intermediate-, and high-risk with post-operative delirium rates of 0% vs. 7% vs. 21%, respectively (chi-square;p<0.001), with the model validated using Brier scores. Patients with postoperative delirium had longer hospital stays (p<0.001) and decreased likelihood of discharge home (p<0.001). Postoperative delirium was independently associated with decreased survival (5.5 vs. 12.0 months, HR=1.8 [1.1-2.7]) in multivariate analysis. CONCLUSIONS: We developed a model to predict development of postoperative delirium using two tumor-specific (bihemispheric tumors and tumor size) and two patient-specific (age and chronic pulmonary disease) factors. High-risk patients and their families should be counseled preoperatively and this risk could be considered in the choice of biopsy versus resection, and resection patients should be monitored closely postoperatively.
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