Impact of Pre-ICU benzodiazepine and Z-Drug exposure on mortality in critically ill Adults: A nationwide retrospective cohort study: A nationwide retrospective cohort study.

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Among patients whose need for intensive care is uncertain, the relationship of intensive care unit (ICU) admission with mortality and costs is unknown. To estimate the relationship between ICU admission and outcomes for elderly patients with pneumonia. Retrospective cohort study of Medicare beneficiaries (aged >64 years) admitted to 2988 acute care hospitals in the United States with pneumonia from 2010 to 2012. ICU admission vs general ward admission. Primary outcome was 30-day all-cause mortality. Secondary outcomes included Medicare spending and hospital costs. Patient and hospital characteristics were adjusted to account for differences between patients with and without ICU admission. To account for unmeasured confounding, an instrumental variable was used-the differential distance to a hospital with high ICU admission (defined as any hospital in the upper 2 quintiles of ICU use). Among 1,112,394 Medicare beneficiaries with pneumonia, 328,404 (30%) were admitted to the ICU. In unadjusted analyses, patients admitted to the ICU had significantly higher 30-day mortality, Medicare spending, and hospital costs than patients admitted to a general hospital ward. Patients (n = 553,597) living closer than the median differential distance (<3.3 miles) to a hospital with high ICU admission were significantly more likely to be admitted to the ICU than patients living farther away (n = 558,797) (36% for patients living closer vs 23% for patients living farther, P < .001). In adjusted analyses, for the 13% of patients whose ICU admission decision appeared to be discretionary (dependent only on distance), ICU admission was associated with a significantly lower adjusted 30-day mortality (14.8% for ICU admission vs 20.5% for general ward admission, P = .02; absolute decrease, -5.7% [95% CI, -10.6%, -0.9%]), yet there were no significant differences in Medicare spending or hospital costs for the hospitalization. Among Medicare beneficiaries hospitalized with pneumonia, ICU admission of patients for whom the decision appeared to be discretionary was associated with improved survival and no significant difference in costs. A randomized trial may be warranted to assess whether more liberal ICU admission policies improve mortality for patients with pneumonia.

Early risk stratification may support emergency department (ED) decision-making for patients hospitalized with heart failure (HF), yet commonly used tools may perform differently across clinically relevant outcomes. We conducted a retrospective observational cohort study using MIMIC-IV (v3.1) linked to MIMIC-IV-ED (2011–2019). Adult ED encounters with HF International Classification of Diseases-9/10 codes from the ED diagnosis table that were linkable to an inpatient admission were included. The primary analytic cohort was restricted to complete-case encounters with sufficient data to compute both Acute Decompensated Heart Failure National Registry (ADHERE) CART and Get With The Guidelines–Heart Failure (GWTG-HF). The primary outcome was 30-day all-cause mortality; secondary outcomes were intensive care unit (ICU) admission within 24 hours after ED disposition, any ICU admission, acute kidney injury (AKI; Kidney Disease Improving Global Outcomes creatinine criteria), and hospital/ICU length of stay. Associations were evaluated using univariable logistic regression. Discrimination was assessed by area under the receiver operating characteristic curve (bootstrap 95% confidence intervals [CI]s) and compared using DeLong test. Calibration was assessed with patient-level 10-fold cross-validated calibration intercept/slope and calibration curves. Among 5508 eligible encounters, 4812 had complete data for both scores and constituted the analytic cohort. Thirty-day mortality occurred in 317/4812 (6.6%). ICU admission within 24 hours after ED disposition occurred in 822/4812 (17.1%), any ICU admission in 1098/4812 (22.8%), and AKI in 1373/4810 (28.5%). GWTG-HF was associated with higher 30-day mortality (odds ratio 2.3 per 10 points, 95% CI 2.1–2.6); ADHERE CART also showed higher odds across strata (group 4 vs 1 odds ratio 5.2, 95% CI 3.1–8.8). Mortality discrimination was higher for GWTG-HF than ADHERE (area under the receiver operating characteristic curve 0.75 vs 0.64; difference 0.10; P < .001), with near-ideal calibration for both. In ED patients hospitalized with HF, GWTG-HF more reliably stratified 30-day mortality risk than ADHERE CART, while both scores showed limited utility for ICU utilization and AKI, supporting outcome-specific and dynamic risk assessment.

Association between hyperglycemia at ICU admission and postoperative acute kidney injury in patients undergoing cardiac surgery: Analysis of the MIMIC-IV database

In-center hemodialysis (HD) patients face greater communicable disease risks, including drug-resistant bacterial colonization and viral hepatitis, compared with home dialysis patients, who limit these risks, avoiding three-times weekly travel to dialysis clinics for treatments (1,2). Minimizing the high coronavirus disease 2019 (COVID-19) morbidity in dialysis patients is essential (3). We explored severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive rates, COVID-19–related hospitalization, mortality, and intensive care unit (ICU) admission by dialysis modality in Ontario, Canada. Data collection was in accordance with Ontario Health's legislative authority under the Ontario Personal Health Information Protection Act of 2004. We linked seven administrative health databases including the Ontario Renal Reporting System, which captures the modality and treatment changes of all adult (>18 years) home dialysis (peritoneal dialysis or home HD) or center-based HD patients across Ontario. Our observation period was between March 1, 2020 and November 20, 2020. For individuals, demographic data, neighborhood income quintile, location, residence in long-term care, comorbidity, hospitalization, ICU admission, deaths, and SARS-CoV-2 provincial RT-PCR testing and results information was obtained. Assuming a 14-day SARS-CoV-2 incubation period, COVID-19 infection was ascribed to the dialysis modality after 14 consecutive days of a home or in-center modality. Patients were followed until death, kidney transplantation, or study end. Follow-up SARS-CoV-2 tests after initial positive results were excluded in ascertaining testing rates. Long-term care residents and regional programs with no COVID-19 infections during the study period were excluded. Event rates for the following were defined as: (1) SARS-CoV-2 tests; (2) positive SARS-CoV-2 tests; (3) initial COVID-19 hospitalization (hospitalization within 1 week of SARS-CoV-2 positivity and/or hospitalization with an international classification of diseases-10 diagnosis of COVID-19); (4) COVID-19 mortality or ICU admission (admission to an ICU with COVID-19 during the initial COVID-19 hospitalization or death within 30 days of COVID-19 admission or SARS-CoV-2 positivity); (5) non–COVID-19 mortality (deaths during the study period not occurring within 30 days of SARS-CoV-2 positivity or COVID-19 admission; and (6) all-cause mortality. Unadjusted and adjusted rate ratios (ARR) for these events were calculated by dialysis modality using a log-binomial model. Logistic regression was used to calculate the adjusted odds ratio (AOR) of hospitalization and ICU admission and/or 30-day mortality by dialysis modality among those with COVID-19 infection. All models were adjusted for factors as indicated in Table 1. Marginal generalized estimating equations and a working dependence correlation structure were used to account for patients contributing patient-times to both modalities. Analyses were performed using SAS Version 9.4 SAS Institute, Cary, NC). Table 1. - Adjusted rate ratios for SARS-CoV-2 and COVID-19 outcomes by dialysis modality Outcome Number with Outcome/ Person Days Rate (per 100,000 person-days) Unadjusted Rate Ratio(95% CI) Adjusted Rate Ratio(95% CI) SARS-CoV-2 tests In-center HD 20804/2,084,665 998 1.0 (Ref) 1.0 (Ref) Home dialysis 2317/761,059 304 0.35 (0.34 to 0.38) 0.37 (0.35 to 0.38) SARS-CoV-2 positive In-center HD 182/2,084,665 8.7 1.0 (Ref) 1.0 (Ref) Home dialysis 34/761,059 4.5 0.59 (0.41 to 0.86) 0.57 (0.39 to 0.83) COVID-19 Hospitalization In-center HD 177/2,084,665 8.5 1.0 (Ref) 1.0 (Ref) Home dialysis 29/761,059 3.8 0.53 (0.38 to 0.75) 0.57 (0.40 to 0.81) COVID-19 ICU admission 30-day mortality In-center HD 45/2,084,665 2.2 1.0 (Ref) 1.0 (Ref) Home dialysis 6/761,059 0.8 0.37 (0.16 to 0.85) 0.44 (0.18 to 1.09) Overall Mortality In-center HD 1030/2,084,665 49.4 1.0 (Ref) 1.0 (Ref) Home dialysis 283/761,059 37.2 0.75 (0.66 to 0.86) 0.94 (0.82 to 1.08) Non-COVID-19 mortality In-center HD 996/2,084,665 47.8 1.0 (Ref) 1.0 (Ref) Home dialysis 278/761,059 36.5 0.76 (0.67 to 0.87) 0.96 (0.83 to 1.09) Mortality reported over the study period. All models adjusted for age, gender, diabetes, length of time on dialysis, race, neighborhood income quintile, geographic location, and prior kidney transplantation. A total of 587 patients contributed to both modalities during the study period. Linked databases included: The Ontario Renal Reporting System, The Registered Persons Database, The Ontario Laboratory Information System COVID-19 database, The Ontario Renal Network COVID-19 data collection tool, The Canadian Institute for Health Information Discharge Abstract Database, The Ontario Health Insurance Plan (was used to determined residency in long-term care), and the Postal Code Conversion File (Statistics Canada; was linked via postal codes to determine neighborhood income quintiles and geographic location). 95% CI, 95% confidence interval; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; COVID-19, coronavirus disease; HD-hemodialysis; ICU, intensive care unit. We identified 3622 home dialysis (n=2853 peritoneal dialysis, n=769 home HD) and 9890 center-based HD patients (761,059 and 2,084,665 person-days, respectively). In-center patients were older (66.0±15 versus 63±15 years) and of longer dialysis vintage (median interquartile range, 2 [1–4] versus 2 [1–3] years), and a greater proportion had diabetes (53% versus 41%) compared with home dialysis patients. Fifty-three percent and 49% of home dialysis and in-center patients were in the greater Toronto area, respectively. SARS-CoV-2 testing rates were lower in home versus in-center dialysis patients (ARR, 0.37; 95% confidence interval [95% CI], 0.35 to 0.38). Six positive SARS-COV-2 episodes occurring within 14 days of dialysis initiation/modality transition were excluded. Positive SARS-CoV-2 tests and COVID-19 hospitalization rates were lower in home compared with in-center dialysis patients. COVID-19–related ICU admission and mortality (ARR, 0.44; 95% CI, 0.18 to 1.09) was lower in home versus in-center patients but did not reach statistical significance (Table 1). Among COVID-19–infected individuals, hospitalization occurred in 85% (29 of 34) and 86% (177 of 205) of home and in-center patients, respectively. Median length of hospitalization (interquartile range; days) was 13 (3–25) for in-center dialysis patients compared with 12 (11–27) for home dialysis patients. Mortality and/or ICU admission occurred in 18% (6 of 34) and 21% (45 of 205) of infected home and in-center patients, respectively. There were no differences in hospitalization (AOR, 1.3; 95% CI, 0.38 to 4.8) or death and/or ICU admission risks (AOR, 1.3; 95% CI, 0.37 to 4.8) in home compared with in-center COVID-19–infected patients. Non-COVID-19–related and overall mortality rates were similar in home versus center-based patients over the study period. We found a lower burden of COVID-19 infection, hospitalization, mortality, and ICU admission in community-dwelling home dialysis versus in-center patients. Our findings may relate to greater case finding in the in-center population, more frequent health care encounters, and routine screening/outbreak surveillance, which was at the program's discretion. If increased testing among in-center HD patients was the only explanation for the higher rates of COVID-19, one would have expected a disproportionate excess of milder cases (i.e., SARS-CoV-2 positivity not requiring hospital admission) among in-center compared with home dialysis patients. However, among in-center HD patients, we also observed higher rates of COVID-19 hospitalization, mortality, and ICU admission that may have been due to a higher infection rate rather than greater case-associated morbidity. Among COVID-19–infected individuals, we found no differences in the adjusted odds of hospitalization and ICU admission or 30-day mortality by home versus in-center treatment (albeit with limited power owing to low event rates). Our study captured over 90% of SARS-CoV-2 provincial tests. A limitation of this study is residual confounding based on unmeasured differences between in-center and home dialysis patients. One cannot exclude case-mix differences in the in-center versus home patients that may have accounted for the differences in COVID-19–related adverse event risks. We also could not distinguish between asymptomatic and symptomatic outpatient cases. Asymptomatic cases may have not been identified in the absence of mass screening. As community transmission of SARS-CoV-2 increased, and as HD facilities intensified infection prevention and control measures, differences in COVID-19 infection rates by dialysis modality may be attenuated compared with our observed findings over the early pandemic period. In the United States, rates of home dialysis continue to increase following the introduction of favorable reimbursement and policy reform (4,5). In addition to other purported benefits, a major shift to home-based dialysis care could render the ESKD population more resilient to the effects of COVID-19, reducing exposure episodes and total exposure time to SARS-CoV-2 while conferring lower future exposure risks to highly transmissible infections. Disclosures P.G. Blake is a contracted Medical Lead and Medical Director at Ontario Renal Network, Ontario Health, has received honoraria from Baxter Global for speaking engagements, and is on the Editorial Board of American Journal of Nephrology. J. Ip, Y. Tang, D. Thomas, and A. Yeung are salaried employees of Ontario Renal Network, Ontario Health. M. Oliver is a contracted Medical Lead at Ontario Renal Network, Ontario Health and is owner of Oliver Medical Management Inc., which licenses Dialysis Management Analysis and Reporting System software. He has received honoraria for speaking from Baxter Healthcare and participated on Advisory Boards for Janssen and Amgen. J. Perl reports grants from the Agency for Healthcare Research and Quality during the conduct of the study; personal fees from AstraZeneca Canada, Baxter Healthcare, DaVita Healthcare Partners, DCI, Fresenius Medical Care, LiberDi, Otsuka, and US Renal Care; research funding and salary support from Arbor Research Collaborative For Health and Agency for Healthcare Research and Quality; speakers bureau for Baxter Healthcare and Fresenius Medical Care; and is on the advisory board for Liberdi, outside of the submitted work. Funding None.

BackgroundEnteral nutrition (EN) in septic shock patients is a double-edged sword. The impact of early enteral nutrition (EEN) on mortality in septic shock patients remains uncertain, and whether this association is modified by vasopressor dosage is also unclear.ObjectiveThe study aimed to investigate the association between EEN and 28-day in-hospital mortality in patients with septic shock and to explore whether the association varied across different dosages of vasopressors during the first 24 h.MethodsData were extracted from the Chinese Database in Intensive Care (CDIC). Adult septic patients who received vasopressors within 24 h of intensive care unit (ICU) admission were eligible for inclusion. The primary exposure was whether patients received early nutrition within the first 24 h after ICU admission (the EEN group). The primary outcome was 28-day mortality. Multivariate Cox regression models were employed to assess the association between the EEN group and 28-day mortality in the overall population and in patients receiving different vasopressor dosing intensity (VDI) levels. VDI was defined as the total vasopressor dose expressed in norepinephrine equivalents (NEEs), calculated as the time-weighted average over the first 24 h.ResultsA total of 26,478 patients were screened and, ultimately, 1855 patients met the inclusion criteria. The median Sequential Organ Failure Assessment (SOFA) score was 11 [interquartile range (IQR): 8–14], and the Acute Physiology and Chronic Health Evaluation (APACHE) II score was 20 (IQR: 15–26). The 28-day in-hospital mortality rate was 19.7%. Compared to patients in the EEN group, those in the late enteral nutrition (LEN) group required higher vasopressor doses (8.7 vs. 10.6 ug/min, p<0.001) and had a higher 28-day mortality rate (16.6% vs. 21.1%, p = 0.03). After adjusting for confounding factors, EEN was not significantly associated with a reduction in the risk of 28-day mortality [Hazard ratio (HR) 0.832, 95% confidence interval (CI) (0.654–1.059), p = 0.135]. When stratified by VDI (norepinephrine equivalents), EEN exhibited a trend toward reduced 28-day mortality; however, this difference failed to reach statistical significance in patients with VDI < 15ug/min [HR 0.738, 95% CI (0.523–1.042), p = 0.084]. In contrast, EEN had no discernible impact on 28-day mortality risk in patients with VDI ≥ 15ug/min [HR 0.926, 95% CI (0.660–1.298, p = 0.655)].ConclusionEarly enteral nutrition was not associated with a lower 28-day mortality risk in patients with septic shock, and it only demonstrated a trend in patients receiving low doses of vasopressors.

EP06.01-005 COVID-19 and Post-COVID Outcomes in Lung Cancer Patients: Experience from an Indian Cancer Center

To assess the impact of delay in emergency department (ED) on outcome of critically ill patients admitted to the medical intensive care unit (MICU). Outcome was defined as hospital mortality and as health-related quality of life (HRQoL) at 6 months after intensive care assessed by the 15D measure. The 15D is a generic, 15-dimensional, standardized measure of HRQoL. We hypothesized that prolonged stay in the ED is related to worse outcome. A prospective follow-up cohort study in university hospital. All consecutive 1675 patients admitted to the MICU between July 2002 and June 2004. The 15D questionnaire was mailed to all patients alive at 6 months after admission. Of all MICU patients, 64% were admitted from ED. The mean length of stay in the ED was 6.2 h (95%CI 5.9-6.5 h). The hospital mortality rate was 24.4% (20.0% in the ED vs. 33.0% in the non-ED cohort, P < 0.001) and it was associated with higher age and degree of physiological derangement at admission. Neither the length of ED stay was associated with hospital mortality (P = 0.82) nor with HRQoL at 6 months after MICU admission (P = 0.34). Altogether, HRQoL at 6 months was significantly lower compared with the age- and sex-matched general population (P < 0.001). In a university hospital, the length of ED stay was not associated with the outcome of critically ill medical patients. However, we feel that the effect of ED treatment and delay on outcome and outcome prediction in the critically ill patients deserves further evaluation.

BackgroundMeasures to improve the accuracy of determining survival and intensive care unit (ICU) admission using the International Classification of Injury Severity Score (ICISS) are not often conducted on a population-wide basis. The aim is to determine if the predictive ability of survival and ICU admission using ICISS can be improved depending on the method used to derive ICISS and incremental inclusion of covariates.MethodA retrospective analysis of linked injury hospitalisation and mortality data during 1 January 2010 to 30 June 2014 in New South Wales, Australia was conducted. Both multiplicative-injury and single-worst-injury ICISS were calculated. Logistic regression examined 90-day mortality and ICU admission with a range of predictor variables. The models were assessed in terms of their ability to discriminate survivors and non-survivors, model fit, and variation explained.ResultsThere were 735,961 index injury admissions, 13,744 (1.9%) deaths within 90-days and 23,054 (3.1%) ICU admissions. The best predictive model for 90-day mortality was single-worst-injury ICISS including age group, gender, all comorbidities, trauma centre type, injury mechanism, and nature of injury as covariates. The multiplicative-injury ICISS with age group, gender, all comorbidities, injury mechanism, and nature of injury was the best predictive model for ICU admission.ConclusionsThe inclusion of comorbid conditions, injury mechanism and nature of injury, improved discrimination for both 90-day mortality and ICU admission. Moves to routinely use ICD-based injury severity measures, such as ICISS, should be considered for hospitalisation data replacing more resource-intensive injury severity classification measures.

To investigate the predictive value of oxygenation index (PaO2/FiO2) at intensive care unit (ICU) admission on 30-day mortality in patients with sepsis. A retrospective study was conducted. Patients with sepsis who were hospitalized in the ICU of the Affiliated Hospital of Jining Medical University from April 2015 to October 2023 were enrolled. The demographic information, comorbidities, sites of infection, vital signs and laboratory test indicators at the time of admission to the ICU, disease severity scores within 24 hours of admission to the ICU, treatment process and prognostic indicators were collected. According to the PaO2/FiO2 at ICU admission, patients were divided into Q1 group (PaO2/FiO2 of 4.1-16.4 cmHg, 1 cmHg ≈ 1.33 kPa), Q2 group (PaO2/FiO2 of 16.5-22.6 cmHg), Q3 group (PaO2/FiO2 of 22.7-32.9 cmHg), and Q4 group (PaO2/FiO2 of 33.0-94.8 cmHg). Differences in the indicators across the four groups were compared. Multifactorial Cox regression analysis was used to assess the relationship between PaO2/FiO2 and 30-day mortality of patients with sepsis. The predictive value of PaO2/FiO2, sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation II (APACHE II) on 30-day prognosis of patients with sepsis was analyzed by receiver operator characteristic curve (ROC curve). A total of 1 711 patients with sepsis were enrolled, including 428 patients in Q1 group, 424 patients in Q2 group, 425 patients in Q3 group, and 434 patients in Q4 group. 622 patients died at 30-day, the overall 30-day mortality was 36.35%. There were statistically significant differences in age, body mass index (BMI), history of smoking, history of alcohol consumption, admission heart rate, respiratory rate, APACHE II score, SOFA score, Glasgow coma score (GCS), site of infection, Combined chronic obstructive pulmonary disease (COPD), blood lactic acid (Lac), prothrombin time (PT), albumin (Alb), total bilirubin (TBil), pH, proportion of mechanical ventilation, duration of mechanical ventilation, proportion of vasoactive medication used, and maximal concentration, length of ICU stay, hospital stay, incidence of acute kidney injury, in-hospital mortality, 30-day mortality among the four groups. Multivariate Cox regression analysis showed that after adjusting for confounding factors, for every 1 cmHg increase in PaO2/FiO2 at ICU admission, the 30-day mortality risk decreased by 2% [hazard ratio (HR) = 0.98, 95% confidence interval (95%CI) was 0.98-0.99, P < 0.001]. The 30-day mortality risk in the Q4 group was reduced compared with the Q1 group by 41% (HR = 0.59, 95%CI was 0.46-0.76, P < 0.001). The fitted curve showed that a curvilinear relationship between PaO2/FiO2 and 30-day mortality after adjustment for confounders. In the inflection point analysis, for every 1 cmHg increase in PaO2/FiO2 at PaO2/FiO2 < 28.55 cmHg, the risk of 30-day death in sepsis patients was reduced by 5% (HR = 0.95, 95%CI was 0.94-0.97, P < 0.001); when PaO2/FiO2 ≥ 28.55 cmHg, there was no statistically significant association between PaO2/FiO2 and the increase in the risk of 30-day death in sepsis (HR = 1.01, 95%CI was 0.99-1.02, P = 0.512). ROC curve analysis showed that the area under the curve (AUC) for the prediction of 30-day mortality by admission PaO2/FiO2 in ICU sepsis patients was 0.650, which was lower than the predictive ability of the SOFA score (AUC = 0.698) and APACHE II score (AUC = 0.723). In patients with sepsis, PaO2/FiO2 at ICU admission is strongly associated with 30-day mortality risk, alerting healthcare professionals to pay attention to patients with low PaO2/FiO2 for timely interventions.

Admission to surgical intensive care unit in time with intensivist coverage and its association with postoperative 30-day mortality: The role of intensivists in a surgical intensive care unit

Association between prehospital shock index and mortality among patients with COVID-19 disease

Sepsis-associated acute kidney injury (SA-AKI) commonly affects critically ill patients, but its early detection remains difficult. Biomarkers that facilitate early detection of patients susceptible to SA-AKI remain essential. This investigation seeks to evaluate the independent association between early serum S100A8/A9 levels and SA-AKI, considering 28-day all-cause mortality as a secondary endpoint. This single-center observational cohort investigation employed a hybrid (ambidirectional) design, enrolling 211 adult sepsis patients per the Sepsis-3 criteria. Among them, 118 developed SA-AKI within 7days, while 93 did not. Serum S100A8/A9 levels were assessed within 2h of intensive care unit (ICU) admission and again on days 1, 3, and 7. Demographic, clinical, and laboratory data were gathered. Multivariable logistic regression and restricted cubic spline analyses assessed the independent relationship between S100A8/A9 at ICU admission and SA-AKI, and receiver operating characteristic curves evaluated its discriminatory ability. Generalized estimating equations were utilized to compare longitudinal S100A8/A9 changes between groups, while Cox proportional hazards models evaluated the connection between S100A8/A9 and 28-day all-cause mortality. Serum S100A8/A9 levels within 2h of ICU admission demonstrated significant elevation in patients developing SA-AKI versus those without AKI [3981.9 (3355.5, 5007.9) pg/mL vs. 3411.8 (2781.5, 3922.5) pg/mL; P < 0.001] and remained elevated on days 1, 3, and 7, despite an overall decline. Generalized estimating equation analysis revealed significant time and group effects (both P < 0.001). At ICU admission, S100A8/A9 was independently associated with SA-AKI (adjusted OR 1.13 per 100pg/mL; 95% CI 1.08-1.19; P < 0.001), with restricted cubic spline analysis indicating an approximately linear relationship. The area under the curve of S100A8/A9 at ICU admission for identifying SA-AKI was 0.721 (95% CI 0.653-0.788), with optimal threshold at 3732.1pg/mL (sensitivity 61.9%, specificity 68.8%). The combined model (SOFA + S100A8/A9) demonstrated enhanced discrimination relative to SOFA alone (area under the curve 0.861 vs. 0.771; DeLong P = 0.0001). In Cox models, S100A8/A9 showed no independent link to 28-day all-cause mortality. Elevated serum S100A8/A9 levels were independently associated with SA-AKI, but no independent link to 28-day all-cause mortality was observed.

A Simple Prognostic Score to Predict Short and Long-Term Survival Following ICU Admission in Critically Ill Adult Allogeneic Hematopoietic Stem Cell Transplant Recipients: Improved Survival Following Reduced Intensity Conditioning

7067 Background: Intensive chemotherapy (IC) used to treat acute myeloid leukemia (AML) is associated with multiple short-term toxicities including mortality, particularly in older adults. Emerging data suggest that baseline quality of life (QOL) assessment and/or objective physical function tests may predict outcomes in oncology, although there are no data in AML patients. We investigated the association between baseline QOL and physical function with short-term treatment outcomes in adult and elderly AML patients. Methods: We conducted a prospective, longitudinal study of adult (age 18+) AML patients undergoing IC. Prior to starting IC, patients completed the EORTC QLQ-C30 and FACT-Fatigue in addition to physical function tests (grip strength, timed chair stands, and 2-minute walk test). Outcomes included 60-day mortality, intensive care unit (ICU) admission, and achievement of complete remission (CR). Univariate and multivariable logistic regression were performed to evaluate each outcome. Results: Of the 243 patients (median age 57.5 y), 56.7% were male and median Charlson comorbidity score was 0. 60-day mortality, ICU admission, and CR occurred in 9 (3.4%), 15 (6.2%), and 171 (70.4%), respectively. In univariate regressions, neither QOL nor physical function tests were predictive of 60-day mortality (all P&gt;0.05), whereas cytogenetic risk group (P=0.04), ICU admission (P=&lt;0.001), and remission status at 30 days (P=0.006) were. Fatigue was a significant predictor of ICU admission (p=0.02) whereas QOL and baseline physical function were not significant predictors. In univariate analyses, higher Charlson score was found to be a significant predictor of both ICU admission (P=0.01) and remission status at 30 days (P=0.002). Cytogenetic risk group was correlated with achievement of CR whereas neither QOL nor physical function were predictive (all P&gt;0.05). Findings were similar when the subset of 96 elderly patients (age 60+) were examined. Conclusions: Baseline QOL and physical function tests in this prospective study were not associated with short-term mortality, ICU admission, or achievement of CR after the 1st cycle of chemotherapy.