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FACTORS ASSOCIATED WITH THE LACK OF FOLLOW-UP IN HELICOBACTER PYLORI ERADICATION TREATMENT: RESULTS FROM THE EUROPEAN REGISTRY ON H. PYLORI MANAGEMENT (HP-EUREG)

Elisa Cantú-Germano 1, Leticia Moreira Ruiz 1, Ángeles Pérez-Aísa 2, Samuel Jesús Martínez-Domínguez 3, Irina Voynovan 4, Luis Bujanda Fernández de Piérola 5, Laimas Virginijus Jonaitis 6, Bojan Tepes 7, Ana Garre Vázquez 8, Alfredo J. Lucendo 9, Frode Lerang 10, Thomas Butler 11, Umud Mahmudov 12, Jose Maria Huguet 13, Javier Tejedor-Tejada 14, Pavel Bogomolov 15, Ian Beales 16, Perminder Phull 17, Manuel Pabon-Carrasco 18, Manuel Castro-Fernández 18, Sergei Alekseenko 19, Matteo Pavoni 20, Oleg Zaytsev 21, Renate Bumane 22, Maja Denkovski 23, Manuel Domínguez Cajal 24, Tatiana Ilchishina 25, Miguel Areia 26, Alma Keco-Huerga 18, Gülüstan Babayeva 27, Fernando Bermejo 28, Halis Simsek 29, Giuseppe Losurdo 30, Dmitry S. Bordin 31, Juozas Kupcinskas 6, Sinead Smith 32, Antonio Gasbarrini 33, Marcis Leja 22, Ricardo Pinto 34, Cem Simsek 35, Blas José Gómez-Rodríguez 36, Pilar Pazo Meijide 37, Ramón Pajares Villarroya 38, Mónica Sánchez Alonso 39, Anna Cano-Catala 40, Pablo Parra 8, Francis Mégraud 41, Colm O'Morain 32, Olga P. Nyssen 8, Javier P. Gisbert 8

Affiliations

1 Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain

2 Hospital Universitario Costa del Sol, Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud (RICAPPS), Marbella, Spain

3 Hospital Clínico Universitario Lozano Blesa, Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Zaragoza, Spain

4 A.S. Loginov Moscow Clinical Scientific Center, Moscow, Russian Federation

5 Hospital Clínico Universitario Lozano Blesa, Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), San Sebastián, Spain

6 Lithuanian University of Health Sciences, Kaunas, Lithuania

7 DC Rogaska, Rogaska Slatina, Slovenia

8 Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain

9 Hospital General de Tomelloso, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM),

10 Østfold Hospital Trust, Grålum, Norway

11 Clinical Medicine, Trinity College Dublin, Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland

12 Modern Hospital, Baku, Azerbaijan

13 Hospital General Universitario de Valencia, Valencia, Spain

14 Hospital Universitario de Cabueñes, Gijón, Asturias, Spain

15 Universal Clinic Private Medical Center, Moscow, Russian Federation

16 Norwich Medical School, University of East Anglia, Norwich, United Kingdom

17 Aberdeen Royal Infirmary, Aberdeen, United Kingdom

18 Hospital Universitario Virgen de Valme, Sevilla, Spain

19 Fare Estern State Medical University, Khabarovsk, Russian Federation

20 Sant'Orsola-Malpighi University Hospital, Bologna, Italy

21 First Clinical Medical Centre, Kovrov, Russian Federation

22 Digestive Diseases Centre, Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia

23 Interni Oddelek, Diagnostic Centre, Bled, Slovenia

24 Hospital Universitario San Jorge, Huesca, Spain

25 SM-clinic, Saint-Petersburg, Russian Federation

26 Portuguese Oncology Institute of Coimbra, Faculty of Medicine of the University of Porto (FMUP), RISE@CI-IPO (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto), Coimbra, Portugal

27 Azerbaijan State Advanced Training Institute for doctors named after A.ALIYEV, Baku, Azerbaijan

28 Hospital Universitario de Fuenlabrada, Madrid, Spain

29 Hacettepe University, Department of Gastroenterology, HC International Clinic, Ankara, Türkiye

30 University of Bari, Bari, Italy

31 A. S. Loginov Moscow clinical scientific center, Department of outpatient therapy and family medicine, Tver State Medical University, Department of propaedeutic of internal diseases and gastroenterology, Moscow, Russian Federation

32 Trinity College Dublin, Dublin, Ireland

33 Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy

34 Centro Hospitalar do Porto, Universidade do Porto, Instituto De Ciências Biomédicas de Abel Salazar, Center for Research in Health Technologies and Information Systems (CINTESIS, Porto, Portugal

35 Hacettepe University, Mehmet Akif Inan, Health Sciences University, Medical Center, HC International Clinic, Ankara, Türkiye

36 Hospital Universitario Virgen Macarena, Sevilla, Spain

37 Hospital de Cruces, Barakaldo, Spain

38 Hospital Universitario Infanta Sofía, Facultad de Medicina, Universidad Europea de Madrid, San Sebastián de los Reyes, Spain

39 Hospital Universitario Santa Bárbara, Puertollano, Spain

40 Gastrointestinal Oncology, Endoscopy and Surgery (GOES) research group, Althaia Xarxa Assistencial Universitària de Manresa, Institut de Recerca i Innovació en Ciències de la Vida i de la Salut de la Catalunya Central (IRIS-CC), Manresa, Spain

41 INSERM U1312, Université de Bordeaux, Bordeaux, France

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Abstract

Introduction

The Maastricht VI/Florence Consensus recommends eradication of all Helicobacter pylori (Hp) infections. However, retreatment strategies after therapeutic failure remain inconsistent.

Aims & Methods

To evaluate the reasons and associated factors for non-retreatment after a failure of Hp eradication treatment.
Systematic, prospective, multicenter, non-interventional registry of clinical practice by European gastroenterologists on the management of Hp infection (Hp-EuReg). Patients who failed eradication treatment between 2013-2024 and were registered in AEG-REDCap were analysed and categorised into two groups: retreatment (control group) and non-retreatment. Reasons for no retreatment were also classified according to either the medical or the patient perspective. Multivariate logistic regression was conducted to identify factors associated with no retreatment from both the patient and medical perspectives, each compared with the control group.

Results

Overall, 6,904 patients were evaluated; 950 (14%) were not retreated: 41% due to a medical decision, 50% due to a patient decision, and 9% due to other reasons. The most frequent reasons for no retreatment were: previous poor tolerance, unclear indication, multiple prior eradication attempts, and previous non-compliance. From the medical perspective, factors significantly associated with no retreatment were: age ≥ 71 years (OR 1.49; 95% CI 1.04-2.13), previous non-compliance (OR 4.27; 95% CI 2.64-6.93), number of previous attempts (OR 2.07-9.25; 95% CI from 1.57-2.73 to 6.15-13.93) and previous treatment discontinuation due to adverse events (OR 2.06; 95% CI 1.19-3.56). From the patient perspective, the factors significantly associated with no retreatment included: being male (OR 1.34; 95% CI 1.10-1.63), having undergone two to four previous eradication attempts (OR 1.69-3.60; 95% CI from 1.16-2.44 to 1.75-7.41) and previous non-compliance (OR 10.04; 95% CI 7.37-13.68).

Factors associated with the lack of H. pylori retreatment after a therapeutic failure – Multivariate analysis
	Retreatment N=5,954	No retreatment Overall N=950	P value OR (95% CI)_{if applicable}	No retreatment Medical perspective N=393	P value OR (95% CI)_{if applicable}	No retreatment Patient perspective N=474	P value OR (95% CI)_{if applicable}
Sex Male Female	2,100 (35.3%) 3,850 (64.7%)	386 (40.6%) 564 (59.4%)	0.000 1.30 (1.12-1.50)	147 (37.4%) 246 (62.6%)	0.116 -	206 (43.5%) 268 (56.5%)	0.004 1.34 (1.10-1.63)
Age 18-70 > 70	5,455 (91.6%) 475 (7.9%)	851 (89.5%) 96 (10.1%)	0.015 1.35 (1.06-1.72)	350 (89.1%) 40 (10.2%)	0.028 1.49 (1.04-2.13)	430 (90.7%) 44 (9.3%)	0.282 -
Number of previous eradication attempts One Two Three Four Five	1.054 (17.7%) 334 (5.6%) 115 (1.9%) 42 (0.7%) 28 (0.5%)	181 (19.1%) 105 (11.1%) 63 (6.6%) 27 (2.8%) 13 (1.4%)	p < 0.05 in all 1.57 (1.30-1.89) 2.82 (2.21-3.61) 5.05 (3.63-7.03) 6.00 (3.61-9.96) 4.04 (4.97-7.41)	82 (20.9%) 61 (15.5%) 39 (9.9%) 12 (3.1%) 5 (1.3%)	p < 0.05 in all 2.07 (1.57-2.73) 4.89 (3.54-6.74) 9.25 (6.15-13.93) 7.84 (3.96-15.53) 4.73 (1.75-12.77)	82 (17.3%) 26 (5.5%) 21 (4.4%) 10 (2.1%) 5 (1.1%)	p < 0.05 only in 2-4 attempts - 1.69 (1.16-2.44) 2.91 (1.78-4.76) 3.60 (1.75-7.41) -
Treatment compliance*	5,647 (94.8%)	739 (77.8%)	0.000 6.07 (4.97-7.41)	303 (77.1%)	0.000 4.27 (2.64-6.93)	358 (75.5%)	0.000 10.04 (7.37-13.68)
Interruption due to AE	183 (3.1%)	109 (11.5%)	0.053 -	68 (17.3%)	0.010 2.06 (1.19-3.56)	39 (8.2%)	0.000 0.34 (0.22-0.55)

OR: odds ratio. CI: confidence interval. AE: adverse events.
* Compliance: > 90% of drug intake.

Conclusion

A significant proportion (14%) of European patients are not retreated after Hp eradication failure. Key barriers include advanced age, a history of poor treatment adherence, and multiple prior eradication failures. The decision to avoid re-treatment was frequently driven by patient-related factors, although medical reasons also played a relevant role, highlighting the importance of shared decision-making and enhanced patient education.

References

1. Gisbert JP, Alcedo J, Amador J, Bujanda L, Calvet X, Castro-Fernández M, et al. V Spanish Consensus Conference on Helicobacter pylori infection treatment. Gastroenterol Hepatol Engl Ed. mayo de 2022;45(5):392-417.
2. Malfertheiner P, Megraud F, Rokkas T, Gisbert JP, Liou JM, Schulz C, et al. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut. septiembre de 2022;71(9):1724-62.
3. Banks M, Graham D, Jansen M, Gotoda T, Coda S, Di Pietro M, et al. British Society of Gastroenterology guidelines on the diagnosis and management of patients at risk of gastric adenocarcinoma. Gut. septiembre de 2019;68(9):1545-75.

Disclosure

Olga P. Nyssen has served as a speaker or has received research funding from Allergan, Mayoly Spindler, Richen, Biocodex and Juvisé.
Javier P. Gisbert has served as speaker, consultant, and advisory member for or has received research funding from Mayoly, Allergan/Abbvie, Diasorin, Richen, Juvisé, Biocodex.
The remaining authors declare no conflicts of interest.

Conference

UEG Week Berlin 2025

Topics

Stomach & H. Pylori

Submission format

Abstract

Session

H. pylori: From epidemiology to therapy (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Umud Mahmudov

LONG-TERM EFFECT OF MACROLIDE CONSUMPTION ON HELICOBACTER PYLORI ERADICATION TREATMENTS: DATA FROM THE EUROPEAN REGISTRY ON H. PYLORI MANAGEMENT (HP-EUREG)

Pilar Pazo Meijide

EFFECTIVENESS OF REPEATED USE OF AMOXICILLIN–CLARITHROMYCIN TRIPLE THERAPY AND BISMUTH QUADRUPLE THERAPY AFTER PRIOR FAILURE: PRELIMINARY RESULTS FROM THE EUROPEAN REGISTRY ON HELICOBACTER PYLORI MANAGEMENT (HP-EUREG)

Umud Mahmudov

THE INFLUENCE OF INDICATIONS FOR HELICOBACTER PYLORI INVESTIGATION ON PRESCRIPTIONS AND EFFECTIVENESS: EUROPEAN REGISTRY ON H. PYLORI MANAGEMENT (HP-EUREG)

Umud Mahmudov

IRISH HELICOBACTER PYLORI ANTIBIOTIC RESISTANCE SURVEILLANCE TO GUIDE CLINICAL PRACTICE

David Kevans

EVALUATION OF MOLECULAR-BASED CLARITHROMYCIN RESISTANCE TESTING IN HELICOBACTER PYLORI COMPARED TO CULTURE-BASED TESTING IN THE IRISH HEALTHCARE SETTING

Sinead Smith

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IRISH HELICOBACTER PYLORI ANTIBIOTIC RESISTANCE SURVEILLANCE TO GUIDE CLINICAL PRACTICE

Thomas Butler 1,2, Stephen Molloy 1, Conor Costigan 1,2, Kevin Van Der Merwe 3, Vikrant Parihar 3, Serhiy Semenov 4, Sharon Hough 5, David Kevans 5, Donal Tighe 4, Deirdre McNamara 2, Sinead Smith 1,2

Affiliations

1 Trinity College Dublin, Dublin, Ireland

2 Tallaght University Hospital, Dublin, Ireland

3 Letterkenny University Hospital, Letterkenny, Ireland

4 Mayo University Hospital, Co. Mayo, Ireland

5 St James's Hospital, Dublin, Ireland

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Antibiotic resistance is one of the main reasons for H. pylori treatment failure. International guidelines recommend that the choice of antibiotics used to treat H. pylori in a given population should be based on the pattern of antibiotic resistance in that region. However, H. pylori antibiotic resistance testing is not routinely carried out in the majority of Irish Hospitals. Recent evidence from the European Helicobacter and Microbiota Study Group has indicated that resistance to certain commonly used antibiotics to eradicate H. pylori varies between European countries, and in certain areas resistance has reached a sufficient level to avoid prescribing these antibiotics as empirical therapy (1). In addition, previous antibiotic use positively correlates with resistance for two major classes of antibiotics commonly used to treat H. pylori infection (1). Because antibiotic resistance is a constantly evolving process, the European Helicobacter and Microbiota Study Group and the Maastricht VI/Florence consensus report (2) have highlighted the importance for local resistance surveys to be carried out on a regular basis in order to guide clinicians in their choice of therapy for successful eradication of H. pylori.

Aims & Methods

In this multisite study we aimed to assess the rate of primary and secondary antibiotic resistance for H. pylori in Ireland, with a view to guiding national treatment strategies. The study comprised of four sites with samples analyzed from two large urban teaching hospitals and two rural teaching hospitals. Patients attending for gastroscopy were invited to participate in the study. Following informed consent, 1 antrum and 1 corpus gastric biopsy were collected from each patient and transported to the laboratory in selective medium. Antibiotic susceptibility testing was carried out by E-test (bioMerieux) and resistance classified according to the EUCAST clinical breakpoints MIC values.

Results

In total, 126 isolates were successfully cultured and antimicrobial susceptibility assessed. 103 of these were isolates of treatment naïve patients (50±16 years old, 59% male) and 23 were of previously treated patients (48±12 years old, 61% female). As can be seen in table 1, primary antibiotic resistance rates have reached alarmingly high levels for both clarithromycin and metronidazole, and reach nearly double the rate of resistance with the previously treated group.

Table 1: Antibiotic susceptibility rates for H. pylori isolated from Irish Hospitals
Antibiotic	clarithromycin	metronidazole	levofloxacin	tetracycline	amoxicillin	rifampicin
Primary Resistance (%)	37.9	44.7	21.4	10.7	33.3	16.7
Secondary Resistance (%)	65.2	73.9	30.4	17.4	30.4	17.4

Conclusion

Antibiotic resistance rates have reached significant levels for all major classes of antibiotics for the treatment of H. pylori. Of note, first-line clarithromycin triple therapy can no longer be recommended in Ireland.

References

(1) Megraud F et al. Helicobacter pylori resistance to antibiotics in Europe in 2018 and its relationship to antibiotic consumption in the community. Gut. 2021
(2) Malfertheiner P, et al Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report Gut 2022;71:1724-1762.
(3) Smith, S. et al. The Irish Helicobacter pylori Working Group consensus for the diagnosis and treatment of H. pylori infection in adult patients in Ireland. Eur. J. Gastroenterol. Hepatol. 29, 552–559 (2017).

Conference

UEG Week Copenhagen 2023

Topics

Stomach & H. Pylori

Submission format

Abstract

Session

PP 02 H. pylori (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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Sinead Smith

Table 1. Effect on treatment effectiveness of the interaction between H. pylori eradication treatments and macrolide consumption in the community throughout the full range of delays between macrolide consumption and treatment.
	Years of delay
	0	1	2	3	4	5	6	7	8
Triple-CA:Macrolides Triple-CM:Macrolides Conco-CAT CAM:Macrolides Seq-CAT-CAM:Macrolides Quad-CAB:Macrolides	0.65 0.35 0.78	0.80 0.50 0.56	0.51 1.25 0.53	0.55 1.18	0.76	0.61 0.60 1.18 6.44	0.56 0.57	0.72 88,000	0.63 0.009
The table displays significant (<0.05) odds ratios for interaction terms in macrolide-based treatments across delay cases. A: amoxicillin; B: bismuth; C: clarithromycin; M: metronidazole; T: tinidazole.

Indications, n (%)	Spain	Russia	Azerbaijan	Italy	Slovenia	Lithuania	Others	Total
Triple-CA Non-investigated Dyspepsia Dyspepsia with normal endoscopy Duodenal Ulcer Gastric Ulcer Preneoplastic lesions GERD Total p-value	577 (75.3)† 1,208 (86.2)* 341 (89.5)* 217 (88.2) 94 (83.9) 35 (89.7) 2,472 (83.9) <0.001	348 (84.9) 847 (82.8) 302 (81.8) 268 (82.0) 52 (92.9) 69 (75.8) 1,886 (82.9) 0.119	37 (92.5) 1,532 (90.9) 134 (93.7) 232 (91.0) 2 (100.0) 27 (96.4) 1,964 (91.2) 0.713	31 (68.9)† 76 (87.4) 21 (91.3) 12 (92.3) 0 (0.0) 5 (83.3) 145 (82.9) 0.015	378 (89.6) 900 (90.7) 199 (94.8) 128 (87.1) 18 (94.7) 282 (92.5) 1,905 (90.9) 0.127	68 (98.6)* 799 (85.4) 65 (78.3)† 38 (88.4) 1 (50.0) 7 (87.5) 978 (85.7) 0.009	920 (82.1)† 1,027 (86.4) 279 (90.6)* 183 (88.0) 125 (88.0) 44 (83.0) 2,578 (85.4) 0.001	2,359 (82.1)† 6,389 (87.4)* 1,341 (88.4)* 1,078 (87.0) 292 (87.4) 469 (88.5) 11,928 (86.4) <0.001
Concomitant-CAT-CAM Non-investigated Dyspepsia Dyspepsia with normal endoscopy Duodenal Ulcer Gastric Ulcer Preneoplastic lesions GERD Total p-value	1,974 (86.8)† 2,097 (89.8) 767 (94.1)* 331 (91.9) 123 (94.6) 73 (89.0) 5,365 (89.5) <0.001	1 (100.0) 30 (88.2) 19 (90.5) 10 (83.3) 0 (0.0) 1 (100.0) 61 (88.4) -	0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) -	57 (95.0) 219 (95.2) 6 (85.7) 14 (87.5) 4 (80.0) 34 (97.1) 334 (94.6) 1.000	3 (75.0) 9 (90.0) 1 (100.0) 1 (100.0) 0 (0.0) 0 (0.0) 14 (87.5) -	0 (0.0) 0 (0.0) 0 (0.0) 1 (100.0) 0 (0.0) 0 (0.0) 1 (100.0) -	220 (92.1) 456 (94.8) 72 (90.0) 32 (91.4) 6 (100.0) 20 (95.2) 806 (93.5) 0.265	2,255 (87.5)† 2,811 (90.9) 865 (93.6)* 389 (91.5) 133 (94.3) 128 (92.1) 6,581 (90.2) <0.001
Quadruple-BMTc Non-investigated Dyspepsia Dyspepsia with normal endoscopy Duodenal Ulcer Gastric Ulcer Preneoplastic lesions GERD Total p-value	1,762 (91.5)† 2,144 (94.1)* 525 (94.8) 302 (92.9) 83 (92.2) 70 (90.9) 4,886 (93.1) 0.017	38 (92.7) 125 (94.0) 21 (91.3) 16 (100.0) 2 (66.7) 0 (0.0) 202 (93.5) 0.722	0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) -	153 (93.9) 403 (95.7) 23 (85.2)† 30 (96.8) 23 (100.0) 19 (90.5) 651 (94.9) 0.049	0 (0.0) 2 (100.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 2 (100.0) -	0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) -	149 (92.0) 350 (90.7) 44 (83.0) 56 (87.5) 10 (100.0) 8 (80.0) 617 (90.1) 0.259	2,102 (91.8)† 3,024 (93.9)* 613 (93.3) 404 (92.7) 118 (93.7) 97 (89.8) 6,358 (93.0) 0.047
Quadruple-CAB Non-investigated Dyspepsia Dyspepsia with normal endoscopy Duodenal Ulcer Gastric Ulcer Preneoplastic lesions GERD Total p-value	274 (91.6) 455 (91.5) 99 (96.1) 45 (97.8) 26 (86.7) 13 (86.7) 912 (92.1) 0.195	219 (94.4) 2,069 (93.3) 389 (91.3) 348 (94.3) 132 (91.0) 58 (89.2) 3,215 (93.1) 0.296	2 (100.0) 157 (98.7) 243 (99.2)* 227 (96.2)† 0 (0.0) 0 (0.0) 629 (98.0) 0.034	0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) -	0 (0.0) 0 (0.0) 0 (0.0) 1 (100.0) 0 (0.0) 1 (100.0) 2 (100.0) -	4 (100.0) 31 (83.8) 3 (100.0) 3 (100.0) 1 (100.0) 0 (0.0) 42 (87.5) -	25 (100.0) 92 (81.4) 31 (72.1)† 10 (100.0) 49 (96.1)* 0 (0.0) 207 (85.5) 0.001	524 (93.2) 2,804 (92.7) 765 (93.3) 634 (95.3) 208 (91.6) 72 (88.9) 5,007 (93.1) 0.113

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