Thrombotic microangiopathies (TMA) are disorders characterized by microangiopathic hemolytic anemia, thrombocytopenia, and microthrombi leading to organ dysfunction. Atypical hemolytic uremic syndrome (aHUS) is a rare subtype of TMA mediated by complement dysregulation. We present a case of a 59-year-old female who presented with acute kidney injury and mild thrombocytopenia but with normal hemoglobin. We highlight the importance of prompt diagnosis of aHUS and initiating appropriate treatment with eculizumab.

No abstract

e16272 Background: Localized pancreatic adenocarcinoma (PDAC) includes resectable, borderline resectable, and locally advanced cancers. In potentially resectable pancreatic cancer, the role of neoadjuvant therapy is evolving and guidelines from expert groups are conflicting. Although limited, randomized trials have shown that neoadjuvant chemotherapy (NCT) can provide survival benefits in patients with localized PDAC. Studies have compared FOLFIRINOX (FFN) with Gemcitabine plus nab-Paclitaxel (G-nP) as first-line NCT for PDAC, but no consensus has been established. As a result, we performed an updated meta-analysis to assess the difference in overall survival between two chemotherapy regimens. Methods: PubMed, EMBASE, and Cochrane databases were systematically reviewed from inception to December 2021 to identify studies comparing FFN with G-nP in the neoadjuvant settings for localized PDAC. The primary outcome was the overall survival of patients and secondary endpoints were RECIST partial or complete response, resection rate and R0 resection. The effectiveness of FOLFIRINOX and G-nP in terms of overall survival in patients with localized PDAC was compared using hazard ratios (HR) and 95% confidence intervals (CI). In addition, the heterogeneity of the studies was evaluated using Cochrane's Q test of heterogeneity and the I2 statistic. Pooled analysis of HR was performed with Stata 17 METAN using random effect model and P of 0.05 was considered statistically significant. Results: We identified 10 studies that met our inclusion criteria. All studies were retrospective and 5 of them were carried out in the United States. The total numbers of patients preoperatively treated with FOLFIRINOX versus G-nP were 988 and 719, respectively. In this meta-analysis compared to G-nP, neoadjuvant FFN was associated with significant prolonged overall survival (HR = 0.72, 95% CI: 0.63–0.82, P < 0.001). FFN group had a significantly higher RECIST partial and complete response rate than the G-nP group, with an OR of 1.65 (95 % CI 1.02-2.68, p = 0.04). For resection rate and R0 resection, FFN group had ORs of 1.65 (95% CI 0.94-2.90, p = 0.08) and 1.91 (95% CI 0.95-3.81, P = 0.07) respectively, both outcomes were statistically insignificant. Conclusions: Results of our meta-analysis show that for localized pancreatic cancer, neoadjuvant treatment with FFN was associated with better survival than G-nP. One limitation to our current study was that all included studies were designed retrospectively. Further randomized clinical trials are needed to explore the ideal neoadjuvant chemotherapy for PDAC.[Table: see text]

e16036 Background: Venous thromboembolism (VTE) is associated with significant morbidity and mortality in cancer patients. Our study compares the mortality in hospitalized VTE patients among the five most common Gastrointestinal (GI) malignancies which includes esophageal, gastric, pancreatic, colorectal, and hepatobiliary cancers. Methods: A retrospective study was conducted utilizing the Nationwide Inpatient Sample database (NIS) from 2016 to 2018. Patients with Venous thromboembolism (VTE) were identified using ICD 10 codes from all primary discharge diagnoses. Only deep venous thrombosis (DVT) and pulmonary embolism (PE) were considered. Patients with VTE were further divided into groups: esophageal cancer, gastric cancer, pancreatic cancer, colorectal cancer, hepatobiliary cancer, and compared with patients who did not have these malignancies. Patients younger than 18 years of age or patients with missing age, gender or race were excluded. Among the hospitalized patients with VTE, we investigated the difference in mortality with different gastrointestinal malignancies. Adjusted odds ratio (OR) was calculated using multivariate regression analysis. Results: Among 751,834 patients discharged with a VTE diagnosis, 0.24% had esophageal cancer, 0.25% had gastric cancer, 0.93% had pancreatic cancer, 1.10% had colorectal cancer, 0.35% had hepatobiliary cancer, and the other 97.14% did not have these malignancies. The study shows that adults admitted to the hospitals for VTE have higher mortality when compared to patients who did not have GI malignancies, with esophageal cancer having the highest inpatient mortality with an OR of 2.66 (95% CI 1.78-3.94, P of 0.00). For the remaining GI cancers, gastric cancer had an OR of 1.74 (95% CI 1.141-2.661, P of 0.010), pancreatic cancer had an OR of 1.74 (95% CI 1.402-2.178 P of 0.000), hepatobiliary cancer had an OR of 1.67 (95% CI 1.144-2.439 P-value of 0.002) and colorectal cancer had OR of 1.18 (95% CI 0.930-1.517 P of 0.169), which was not statistically significant. Conclusions: Pancreatic and gastric cancers have a higher risk of VTE and frequently score high in validated VTE risk assessment tools such as the Khorana score. This study shows that VTE in hospitalized patients with esophageal cancer is associated with greater mortality. More research is needed to analyze the outcomes of VTE in cancer patients and to identify those who would benefit from thromboprophylaxis. Due to the nature of the NIS database, one of the study's limitations was the difficulty in identifying patients receiving DVT prophylaxis.

e16778 Background: Several epidemiologic studies have illustrated a general association between diabetes mellitus and pancreatic cancer (PC). Very few, however, described a temporal association between the new onset of diabetes mellitus, particularly within the first 2 years of diagnosis, and the development of PC. We sought to systematically review the literature and perform the first meta-analysis to study the risk of PC among patients with new-onset diabetes mellitus (NOD). Methods: A systematic literature search was conducted in PubMed, MEDLINE, EMBASE, and Cochrane databases from inception through November 2019 to identify studies evaluating the relationship between NOD and PC. NOD was defined as diabetes mellitus diagnosed within 3 years or less prior to diagnosis of PC. Studies were examined and relevant data was extracted and analyzed using Comprehensive Meta-Analysis software. A random effect meta-analysis approach was used to pool the data and odds ratio was used to calculate the overall effect estimate. Results: A total of 283 articles were identified by the search but only 4 relevant studies met our inclusion criteria and they examined a total of 42055 cases and 2402213 controls. The odds ratio of pancreatic cancer development among patients with NOD was 3.021 (CI 2.192- 4.165) compared to controls with significant heterogeneity (I2= 90%). Meta regression evaluating relevant variables such as mean age, race and smoking were not able to explain the heterogeneity. A meta-regression model accounting for sample size as an independent factor showed that sample size was inversely correlated to the OR of PC in patients with NOD and was able to explain 93% of the noted heterogeneity between studies. Conclusions: Our meta-analysis has shown a significant temporal association between NOD and pancreatic cancer. Diabetes mellitus, being mostly diagnosed in an outpatient setting by primary care physicians (PCPs), can be the first clue to detect pancreatic cancer at an early stage, and thus contribute to more favorable outcomes. These findings might guide PCPs to consider pancreatic cancer in the differential diagnosis in high risk patients. Further studies are needed to discern the role of NOD in pancreatic cancer screening. Attention is required to the possible inflationary effect of low sample sizes on the odds of developing PC after NOD.