Mortality In Affected Patients Research Articles

Survival Analysis of Patients with Covid-19 Using Parametric Models in the Presence of Frailty Variable: A Prospective Cohort Study

Introduction: This study was performed to investigate the survival analysis of patients using parametric models in the presence of fragility variables. Methods: The data of this research belonged to a prospective cohort study of all the patients with Covid-19 in Fereydunshahr City. By conducting PCR tests on 2269 individuals suspected of Covid-19, 880 definite patients of Covid-19 were identified by census method. The death of the patients due to Covid-19 was the failure event. The response variable was the time from the onset of symptoms to the time of death (or censoring) at the end of the study. The data were analyzed through SPSS (version 16) and R software (version 4.3.2) at an error level of 0.05 and fitted with survival parametric models (considering the gamma distribution for the frailty variable) using Akaike's criterion. Results: Based on multiple regression analysis, the risk of death in patients with a history of heart disease was 4.9 times more than of patients without heart disease (95% CI for HR=2.21-10.98, HR=4.9) and in hospitalization patients was 4.2 times more than of outpatient cases (HR=4.2, 95% CI for HR=1.74-10.24). Moreover, increasing the age showed a significant relationship with the mortality rate (95% CI for HR=1.02-1.08, HR=1.05). With the inclusion of fragility variable in the model, the variable of “cardiovascular disease” was recognized as an important risk factor in survival time of patients; while without the fragility variable, this variable was ignored. In this study, according to the Akaike's criterion, the log-normal model showed a goodness of fit with the Covid-19 data. Conclusion: Using the fragility variable in survival regression models of patients with Covid-19, it is possible to identify the factors affecting patient mortality that it’s impossible to identify these risk factors in conventional models.

Transplantation Within 6 Months of Registration does not Enhance Survival for Patients with Perihilar Cholangiocarcinoma.

Determine if timing of transplantation affects patient mortality. Neoadjuvant therapy and liver transplantation has emerged as an excellent treatment option for select patients with perihilar cholangiocarcinoma (pCCA). However, the optimal timing of transplantation is not known. We reviewed all patients registered for a standardized pCCA protocol between 1996 - 2020 at our center. After adjusting for confounders, we examined the association of waiting time with patient mortality in an intention-to-treat cohort (n=392) and those who received a liver transplant (n=256). The median (interquartile range) time from registration to transplant or drop out was 5.74 (3.25-7.06) months. Compared to a short wait time (0-3 months), longer waiting times did not affect all-cause mortality: (3-6 months) hazard ratio (HR) 0.98; 95% CI 0.52-1.84; (6-9 months) HR 0.80; 95% CI 0.39-1.65; (9-12 months) HR 0.56; 95% CI 0.26-1.22. Subgroups with a shorter waiting time had similar survival to those with long waiting times: living donor available HR 0.97; 95% CI 0.67-1.42; AB or B blood group HR 0.93; 95% CI 0.62-1.39. Longer waiting times were associated with decreased all-cause mortality after transplantation (HR 0.92; 95% CI 0.87-0.97). This benefit began after a 6 month waiting time minimum (HR 0.53; 95% CI 0.26-1.10) and increased further after 9 months (HR; 0.43 95% CI 0.20-0.93). Waiting time was not associated with residual adenocarcinoma in the explant (odds ratio 0.99; 95% CI 0.98-1.00). A waiting time of at least 6 months will optimize results with transplantation without affecting overall (intention-to-treat) patient survival.

Vancomycin Resistant Enterococcus in Infected Walled Off Necrosis: Possible Causation & Management

Peri-pancreatic fluid collections are frequently encountered by clinicians caring for patients who recover from acute or chronic pancreatitis. Although these fluid collections are common, the type of collection and resulting complications can significantly affect patient mortality. We present a 29-year-old female who originally presented with acetaminophen toxicity secondary to pain management for interstitial edematous pancreatitis (IEP) complicated by renal failure. The patient later developed intermittent fevers with concern for an underlying infection and was ultimately found to have walled-off necrosis (WON) infected by an uncommon hepaPeri-pancreatic fluid collections are frequently encountered by clinicians caring for patients who recover from acute or chronic pancreatitis. Although these fluid collections are common, the type of collection and resulting complications can significantly affect patient mortality. We present a 29-year-old female who originally presented with acetaminophen toxicity secondary to pain management for interstitial edematous pancreatitis (IEP) complicated by renal failure. The patient later developed intermittent fevers with concern for an underlying infection and was ultimately found to have walled-off necrosis (WON) infected by an uncommon hepatobiliary pathogen previously isolated in a urine culture despite asymptomatic bacteriuria. Background: Acute pancreatitis (AP) is divided into two categories: IEP and necrotizing pancreatitis (NP). Fluid collections are a common sequala for both subtypes. In IEP, fluid collections include acute peripancreatic fluid collections (APFCs) and pseudocysts (PC). Fluid collections in NP include acute necrotic collections (ANCs) and walled-off necrosis (WON) (1). All associated AP fluid collections carry an increased risk for infection, but speed and degree of management varies depending on the collection type (2). Objective: To report a case of AP complicated by a miscategorized fluid collection later determined to be WON with superimposed vancomycin resistant enterococcus (VRE) and discuss a unique approach to anti-microbial therapy selection. Atobiliary pathogen previously isolated in a urine culture despite asymptomatic bacteriuria.

Demystifying COVID-19 mortality causes with interpretable data mining

While COVID-19 becomes periodical, old individuals remain vulnerable to severe disease with high mortality. Although there have been some studies on revealing different risk factors affecting the death of COVID-19 patients, researchers rarely provide a comprehensive analysis to reveal the relationships and interactive effects of the risk factors of COVID-19 mortality, especially in the elderly. Through retrospectively including 1917 COVID-19 patients (102 were dead) admitted to Xiangya Hospital from December 2022 to March 2023, we used the association rule mining method to identify the risk factors leading causes of death among the elderly. Firstly, we used the Affinity Propagation clustering to extract key features from the dataset. Then, we applied the Apriori Algorithm to obtain 6 groups of abnormal feature combinations with significant increments in mortality rate. The results showed a relationship between the number of abnormal feature combinations and mortality rates within different groups. Patients with “C-reactive protein > 8 mg/L”, “neutrophils percentage > 75.0 %”, “lymphocytes percentage < 20%”, and “albumin < 40 g/L” have a 2×\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\ imes$$\\end{document} mortality rate than the basic one. When the characteristics of “D-dimer > 0.5 mg/L” and “WBC > 9.5×109\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$9.5 \ imes 10^9$$\\end{document} /L” are continuously included in this foundation, the mortality rate can be increased to 3×\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\ imes$$\\end{document} or 4×\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\ imes$$\\end{document}. In addition, we also found that liver and kidney diseases significantly affect patient mortality, and the mortality rate can be as high as 100%. These findings can support auxiliary diagnosis and treatment to facilitate early intervention in patients, thereby reducing patient mortality.

Clinical Presentation and Outcomes of Hospitalized Patients with Chronic Kidney Disease and COVID-19 Variant Omicron.

To investigate the clinical characteristics of hospitalized patients with chronic kidney disease (CKD) and novel coronavirus (SARS-CoV-2) infection and identify potential risk factors that contribute to mortality. This is a retrospective study, conducted on patients with CKD who were admitted to the First Medical Center of the People's Liberation Army General Hospital between December 1, 2022, and February 28, 2023. All patients were also infected with SARS-CoV-2. We analyzed the clinical characteristics of patients, and the patients were categorized into a survival group and a death group whosecharacteristics were compared. Cox regression analysis was used to identify risk factors that affected patient prognosis. A total of 406 patients were enrolled in this study, including 298 males (73.4%). The average age was 80.5 (67.0, 88.0) years, and the patients had an average estimated glomerular filtration rate (eGFR) of 50.3 (25.0-79.0) mL/min/1.73m². A total of 158 individuals died during hospitalization, resulting in a mortality rate of 38.9%. Renal function was worse in the death group than in the survival group (P < 0.001). Patients in the death group had more severe COVID-19 disease and higher CKD staging than those in the survival group (all P values < 0.001). Multivariate Cox regression analysis identified several risk factors that affected patient mortality, including being male, a higher resting heart rate (RHR) upon admission, dyspnea, a low lymphocyte count (Lym), a high international standardized ratio (INR), a high Acute Physiology and Chronic Health Evaluation II (APACHE II) score, heart failure, and the need for mechanical ventilation during the disease. Hospitalized patients with CKD who were infected with SARS-CoV-2 (38.9%) had a relatively high mortality rate (38.9%). Furthermore, a marked correlation was observed between a reduced eGFR and an increased risk of mortality.

Bacteremia and Mortality among Patients with Nontunneled and Tunneled Catheters for Hemodialysis.

Central venous catheters for hemodialysis (HD) can be nontunneled catheters (NTC) or tunneled catheters (TC). Bacteremia and dysfunction are complications that can impact morbidity and mortality. We decided to compare the rates of bacteremia and dysfunction between NTC and TC and patient survival 90 days after catheter insertion. Retrospective cohort to evaluate catheters inserted between January 2011 and December 2020 in a tertiary hospital. Catheters in patients with end-stage chronic kidney disease were included. Patients with acute kidney injury, catheters that lasted less than three HD sessions, and patients who died within one week after insertion were excluded. Bacteremia and dysfunction rates, bacteremia-free survival, and dysfunction-free survival were investigated. Multivariable analysis was performed using a Cox proportional hazards regression model for patient survival at 90 days. 670 catheters were analyzed in 287 patients, 422 NTC (63%), and 248 TC (37%). The rates of confirmed bacteremia per 1,000 catheter-days were 1.19 for NTC and 0.20 for TC (p < 0.0001). The confirmed or possible bacteremia rates were 2.27 and 0.37 per 1,000 catheter-days for NTC and TC, respectively (p < 0.0001). The dysfunction rates were 3.96 and 0.86 for NTC and TC, respectively (p < 0.0001). Patient survival at 90 days was higher in the TC group than the NTC group (96.8% vs. 89.1%; p < 0.0001). We found lower rates of bacteremia and dysfunction for TC and demonstrated that using NTC affects patient mortality.

DEVELOPMENT AND VALIDATION OF A NOMOGRAM FOR PREDICTING 28-DAY IN-HOSPITAL MORTALITY IN SEPSIS PATIENTS BASED ON AN OPTIMIZED ACUTE PHYSIOLOGY AND CHRONIC HEALTH EVALUATION II SCORE.

Purpose : The objective of this study is to establish a nomogram that correlates optimized Acute Physiology and Chronic Health Evaluation II (APACHE II) score with sepsis-related indicators, aiming to provide a robust model for early prediction of sepsis prognosis in clinical practice and serve as a valuable reference for improved diagnosis and treatment strategies. Methods : This retrospective study extracted sepsis patients meeting the inclusion criteria from the MIMIC-IV database to form the training group. An optimized APACHE II score integrated with relevant indicators was developed using a nomogram for predicting the prognosis of sepsis patients. External validation was conducted using data from the intensive care unit at Lanzhou University Second Hospital. Results : The study enrolled 1805 patients in the training cohort and 203 patients in the validation cohort. A multifactor analysis was conducted to identify factors affecting patient mortality within 28 days, resulting in the development of an optimized score by simplifying evaluation indicators from APACHE II score. The results showed that the optimized score (area under the ROC curve [AUC] = 0.715) had a higher area under receiver operating characteristic curve than Sequential Organ Failure Assessment score (AUC = 0.637) but slightly lower than APACHE II score (AUC = 0.720). Significant indicators identified through multifactor analysis included platelet count, total bilirubin level, albumin level, prothrombin time, activated partial thromboplastin time, mechanical ventilation use and renal replacement therapy use. These seven indicators were combined with optimized score to construct a nomogram based on these seven indicators. The nomogram demonstrated good clinical predictive value in both training cohort (AUC = 0.803) and validation cohort (AUC = 0.750). Calibration curves and decision curve analyses also confirmed its good predictive ability, surpassing the APACHE II score and Sequential Organ Failure Assessment score in identifying high-risk patients. Conclusions : The nomogram was established in this study using the MIMIC-IV database and validated with external data, demonstrating its robust discriminability, calibration, and clinical practicability for predicting 28-day mortality in sepsis patients. These findings aim to provide substantial support for clinicians' decision making.

Complications of Type 2 Mellitus Diabetes in the Ecuadorian Population: A Bibliographic Review

Introduction: Diabetes Mellitus Type 2 (DMT2) is a major public health concern in Ecuador due to its high prevalence and the array of complications it brings to those afflicted. Over recent decades, the incidence of DMT2 has shown a significant increase in Ecuador, impacting the quality of life and the healthcare systems significantly. Objective: the study aims to review and synthesize existing literature on the complications of DMT2 within the Ecuadorian population, highlighting the burdens and management gaps. Methodology: a bibliographic search was conducted across several databases, including PubMed and Web of Science, with search terms related to diabetes, nutrition, and complications. Criteria for inclusion were studies relating to DMT2 and its complications conducted in Ecuador and published in either English or Spanish. Data from 30 relevant articles were selected and analyzed based on their content and focus. Results: the findings revealed a worrisome increase in mortality associated with DMT2, with 4,895 deaths recorded in 2017 and an increase to 5,051 in 2022, making it a leading cause of death in Ecuador. Frequent complications include severe cardiovascular issues, diabetic nephropathy, and diabetic retinopathy, each significantly affecting patient mortality and quality of life. The review highlighted deficiencies in the prevention and management of DMT2, noting the insufficiency of current strategies against established risk factors such as obesity, dyslipidemia, sedentarism, and smoking. Conclusion: the review emphasizes the critical need to strengthen public health policies and educational and self-care programs for diabetes in Ecuador. Enhancements in these areas could significantly reduce the disease's burden and improve health outcomes for the Ecuadorian population

Body mass Index does not impact long-term survival of patients with idiopathic pulmonary fibrosis undergoing lung transplantation.

We investigated the impact of body mass index (BMI) on post-operative outcomes and survival of patients with interstitial pulmonary fibrosis (IPF) undergoing lung transplantation. We retrospectively reviewed 222 patients with IPF that underwent lung transplant (LT) at our institution from 2005 to 2019. Recipients were divided in 4 groups: group-1 consisted of underweight patients (BMI ≤18.5 kg/m2), group-2 of normal weight patients (BMI 18.5-25 kg/m2), group-3 of over-weight patients (BMI 25-29.9 kg/m2) and group-4 of obese patients (BMI ≥30 kg/m2). Group-1 consisted of 13 (6%) patients, group-2 of 67 (30%) patients, group-3 of 79 (36%) patients, group-4 consisted of 63 (28%) patients. Median BMI for group-1 was 17 [interquartile range (IQR): 17, 18], for group-2 was 23 (22, 24), for group-3 was 29 (28, 29.5) and group-4 was 32 (31, 33). Patients in group-1 were significantly younger (p < 0.01). Single LT comprised the majority of operation type in group-2 to group-4 and it was significantly higher than group 1 (p < 0.01). Median follow-up time was 39 months (13-76). A total of 79 (35.5%) patients died by the end of study. Overall, five deaths occurred in group-1, 17 in group-2, 33 in group-3, and 24 in group-4. Kaplan-Meier analysis showed that mortality was not statistically significant between the groups (p = 0.24). Cox-regression analysis was used to assess other possible risk factors that could influence the effect of BMI on mortality, including transplant type (single, double), lung allocation score, and age, diabetes and creatinine levels at surgery. None of these factors were shown to affect patient mortality (p > 0.05). Overall reasons for death included graft failure (24%), infection (23%), respiratory failure (14%), and malignancy (13%). Body mass index does not impact long-term survival of patients with IPF undergoing lung transplantation.

Restructuring of the UK Vascular Services: does the hub versus spoke model affect patient mortality in ruptured abdominal aortic aneurysms?

Background: Ruptured abdominal aortic aneurysms (AAA) are a frequently fatal vascular condition. The centralisation of vascular services in the UK was driven by the positive volume–outcome relationship witnessed within vascular surgery and other major surgical specialities. In 2018, The Get It Right First Time (GIRFT) programme officially recommended the restructuring of vascular services in England to a hub and spoke model where AAA repairs should be performed in higher volume centres, the hub sites. This study aims to assess the mortality rates in patients presenting at hub versus spoke sites in the Merseyside region. Methods: We conducted a retrospective review from 1 January 2017 to 31 December 2020, identifying 110 patients with a ruptured AAA presenting to hub and spoke sites. We determined if there was any association between mortality and the presenting site. Results: Forty-one patients presented to the hub site (Royal Liverpool University Hospital) and 69 patients to the spoke sites. 81% underwent operative intervention and 19% died in Accident and Emergency or were palliated. 57% of those who underwent an intervention survived. The overall mortality rate in hospital was 53% (58 patients). There was no association between mortality and transfer from a spoke site (p=0.585). Conclusion: This study is concordant with further published data supporting the centralisation of services for ruptured AAA.

Prognosis of Amphotericin B in the Treatment of Breakthrough Candidemia in Patients with Hematologic Malignancies

Background Candidemia is greatly affects patient mortality, especially in patients with malignant hematologic diseases, despite improvements in diagnosis, prophylaxis, and management, but also with a crude mortality rate of 25-50% . The choice of the antifungal therapy for candidemia must take into account several factors such as type of patient, presence of devices, severity of illness, recent exposure to antifungals, local epidemiology, organs involvement, and Candida species. Echinocandin is a broad-spectrum antifungal agent that is effective against most Candida species,and also choice for neutropenic patients, but their resistance limits their clinical application, especially for immunodeficient patients we often need stronger antifungal drugs, Amphotericin B and liposomal amphotericin B are still widely used, and the effectiveness and safety of both are subject to further clinical analysis. Objective Analyze the clinical characteristics of patients with hematologic malignancies complicated by candidemia. compared the prognosis of patients with candidemia treated with amphotericin B and amphotericin B liposomes, and compared the differences in overall survival rate of breakthrough candidemia between patients who received or did not receive allogeneic hematopoietic stem cell transplantation. Method We collected clinical and microbiological data from a single centre of patients with hematological malignancies and breakthrough candidemia, recording results at 7, 30 and 100 days of follow-up, comparing the prognosis of patients with hematological malignancies complicated by breakthrough candidemia with amphotericin B. Kaplan-Meier survival estimates were used to generate survival curves. Result Of 30 enrolled patients, 10 were diagnosed with acute lymphoblastic leukaemia, 10 with acute myeloid leukaemia, 2 with chronic myeloid leukaemia, 4 with lymphoma, 3 with myelodysplastic syndrome and 1 with aplastic anemia. All patients had agranulocytosis during the course of the disease, with a median duration of 19.5 days of agranulocytosis, and 28 of these patients had sepsis at the time of agranulocytosis. Of the 30 pathogenic breakthrough Candida strains, one was Candida albicans, one was Candida guilliermondi, three were Candida subsmoothis and 25 were Candida tropicalis. 14 of these patients received hematopoietic stem cell transplants. Attributable mortality was 5/14 (35.71%) and 4/12 (33.33%) in the transplant and non-transplant groups respectively (P=0.694).At day 7, 30 and 100, overall survival rates were 100%, 82.6% and 39.1% for patients in the amphotericin B group and 85.6%, 28.6% and 28.6% for patients in the non-amphotericin B group respectively, with significant differences in 30-day survival rates between the two groups(P=0.00051). We found that among patients in the transplant group, the overall survival rates at 30 and 100 days were 91.0% and 36.3% for patients using amphotericin B, respectively, and 0% and 0% for patients without amphotericin B at 30 and 100 days, and that there was a significant difference between them (P=0.0025, P=0.0023). In the transplant group, the overall survival rates at 30 and 100 days were higher in patients with post-transplant candidemia than in those with peri-transplant candidemia, but none of the differences were statistically significant (P=0.40, P=0.38). Conclusion Early candidemia in transplant patients severely affects patient prognosis, increasing non-recurrent post-transplant mortality and reducing overall survival. Amphotericin B has shown good efficacy in the treatment of breakthrough candidemia in both transplant and non-transplant patients, and although the guideline recommendation for candidemia is caspofungin or micafungin, amphotericin and amphotericin liposomes as an alternative, the choice of antifungal agent for breakthrough candidemia in immunodeficient patients may need to be patient-specific.

Predictors of In-Hospital Mortality in Non-Elderly Adult Patients Emergently Admitted with Rhabdomyolysis: A 10-Year Analysis of 27,688 Patients from the National Inpatient Sample.

Rhabdomyolysis is a condition where muscle damage leads to the leakage of intracellular contents such as myoglobin and creatine kinase. These leak into systemic circulation and can cause detrimental effects. Due to the detrimental effect of rhabdomyolysis on patient mortality and potential complications, identifying factors that affect patient mortality in those with rhabdomyolysis could provide valuable insight in early management strategies and potentially benefit patient outcomes. The goal of this study was to identify independent predictors of in-hospital mortality in non-elderly adult patients who underwent emergency admission due to rhabdomyolysis. A retrospective cohort study was done by analyzing 27,688 non-elderly adult patients (18-64 years) with rhabdomyolysis who underwent emergency admission using the National Inpatient Sample (NIS) during 2005-2014. Factors such as demographic information, clinical course, and comorbidities were collected to identify predictors of in-hospital mortality. Chi square and student's t-tests were utilized to evaluate various group differences on categorical and continuous variables. Backward logistic regression analyses were performed to examine factors that could affect patient mortality. A total number of 27,688 non-elderly adult patients (age 18-64 years) were included, of which, 20,137 patients were male (72.8%) with a mean (SD) age of 40.60 (13.34) years, and 7,551 patients were female (27.3%) with a mean (SD) age of 45.63 (13.20) years. Multivariable backward logistic regression analysis was performed to evaluate the associations between mortality and different variables in our patient sample. Out of different factors, respiratory diseases, cardiac disease, and genitourinary system disease demonstrated the most significant association with mortality, shown by odds ratios of 3.67, 3.59, and 3.08, respectively. Additionally, patient age, history of surgical procedure, bacterial infection (other than tuberculosis), and cerebrovascular diseases were also positively associated with mortality. Their respective odds ratios were 1.03, 2.14, 2.13, and 2.66. Each additional year in age leads to 3% increased odds of mortality in non-elderly adult patients who are emergently admitted with rhabdomyolysis.

Implementation of a regional multidisciplinary veno-venous extracorporeal membrane oxygenation unit improved survival: a historical cohort study.

PurposeVeno-venous extracorporeal membrane oxygenation (vvECMO) is a highly invasive technique with a high risk of mortality. Based on reports of improved outcomes in high-volume ECMO centers, we established a regional vvECMO unit. The objective of this study was to evaluate how the vvECMO unit affected patient mortality rates.MethodsThis was a historical cohort study of all patients admitted to Dijon University Hospital and supported by vvECMO between January 2011 and June 2021. Patients managed with the vvECMO unit were compared with patients managed with non-vvECMO units. The primary outcome was 90-day mortality.ResultsOf 172 patients treated using vvECMO, 69% were men, and the median [interquartile range] age was 59 [48–66] yr. Of the 172 patients, 35 were treated in the vvECMO unit and 137 were treated elsewhere (110/137 before the unit was established and 27/137 after). Ninety-day mortality was lower in patients managed in the vvECMO unit (15/35, 43% vs 92/137, 67%; P = 0.005). Within the vvECMO unit, mortality rates were also lower for the subgroup of patients managed after the specialized unit was established (15/35, 43% vs 20/27, 74%; P = 0.002). After adjusting for baseline severity of illness at vvECMO initiation, the vvECMO unit was independently associated with a lower 90-day mortality rate (hazard ratio, 0.41; 95% confidence interval, 0.21 to 0.80).ConclusionThe establishment of a vvECMO unit was associated with reduced 90-day mortality. This improved survival may relate to patient selection, more specialized mechanical ventilation support, and/or improvement of vvECMO care.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12630-022-02259-4.

Risk factors and prognostic model for HBV-related subacute liver failure

BackgroundThe prognosis for patients with chronic hepatitis B virus (HBV)-related subacute liver failure is poor. Thus, accurate prognostication would facilitate management and optimize liver allocation. This study aimed to explore the risk factors for HBV-related subacute liver failure and establish a risk model.MethodsA total of 192 patients with HBV-related subacute liver failure treated at the First Affiliated Hospital of Xi’an Jiaotong University during January 2018 to January 2019 were selected and divided into the survival group (n=113) and the death group (n=79) based on their status within 6 months. Patient information were collected, including age, sex, body mass index, complications, hepatitis B e antigen (HBeAg), hepatic encephalopathy, hepatorenal syndrome, infections, ascites, HBV-DNA, Model for End-Stage Liver Disease (MELD), liver function tests, international normalized ratio (INR), serum creatinine and total cholesterol. Binary logistic regression was employed to identify risk factors for risk model establishment. The predictive value of the risk model was assessed with a receiver operating characteristic (ROC) curve.ResultsCompared with the survival group, the patient age, incidence of hepatic encephalopathy and hepatorenal syndrome, infection and ascites rate, MELD score, and alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), INR, and serum creatinine levels were significantly elevated, whereas the total cholesterol level was significantly decreased in the death group (all P<0.05). Patient age [odds ratio (OR) =1.11, P=0.03], hepatic encephalopathy (OR =8.31, P=0.02), infection (OR =4.27, P=0.005), ascites (OR =4.54, P=0.006), MELD score (OR =1.39, P<0.001), INR (OR =5.89, P=0.001), and total cholesterol (OR =0.31, P=0.002) were identified as prognostic factors affecting patient mortality. Although both the MELD score and the risk model established in the present study could differentiate patient outcomes, the area under the curve (AUC) (0.94 vs. 0.82, P<0.001) and sensitivity (91.1% vs. 58.2%, P<0.001) of the established risk model were significantly higher than those of the MELD score.ConclusionsPatient age, hepatic encephalopathy, infection, ascites, MELD score, INR, and total cholesterol level were independent prognostic factors. The prognostic model established based on these risk factors may have favorable predictive value.

51 Restructuring of the UK Vascular Services: Does the Hub and Spoke Model Affect Patient Mortality in Ruptured AAAs?

Abstract Aim Ruptured Abdominal Aortic aneurysms (rAAA) are a fatal vascular condition. In 2018, The Get It Right First Time Programme (GRIFT) recommended the restructuring of vascular services in England to a Hub and Spoke model where AAA repairs should be performed in higher volume centres, the hub sites. This study aims to assess the mortality rates in patients presenting at hub versus spoke sites in the Merseyside region. Method We conducted a retrospective review, 1st January 2017 to 31st December 2020, recognising 110 patients with a rAAA presenting to hub and spoke sites in the Merseyside Region. We determined if there was any association in mortality and the presenting site. We also assessed the mean time to theatre for both Hub and Spoke patients. Results 41 patients presented to Hub site and 69 patients to the spoke sites. 81% underwent operative intervention and 19% died in A+E or were palliated. 57% of those who underwent an intervention survived. Overall mortality rate in hospital was 53% (58 patients). There was no association between mortality and transfer from a spoke site (p = 0.58). The median time to theatre for Hub patients was 160 minutes from presentation and 315 minutes from Spoke sites. Time to theatre had no overall effect on mortality (p = 0.1) Conclusions This study indicates that the GRIFT programme does not have a negative effect on mortality irrespective of time taken to theatre. Therefore, transferring patients to a specialist hub site will positively influence patient outcomes.

Variability of Mammographic Imaging Surveillance in Breast Cancer Survivors.

Variability of Mammographic Imaging Surveillance in Breast Cancer Survivors.

Does time-to-surgery affect mortality in patients with acute osteoporotic vertebral compression fractures?

IntroductionOsteoporotic vertebral compression fractures (VCFs) are common. An increase in mortality associated with osteoporotic VCFs has been well documented. The purpose of this study was to assess the impact of time to surgery on 1-year survival in patients with osteoporotic vertebral compression fractures.MethodsIn a retrospective cohort study with prospective mortality follow-up, consecutive patients aged ≥ 60 years who had operative treatment of a low-energy fracture of a thoracolumbar vertebra and had undergone surgical stabilization between January 2015 and December 2018 were identified from our institutional database. By chart review, additional information on hospitalization time, comorbidities (expressed as ASA - American Society of Anesthesiologists Scale), complications and revision surgery was obtained. Time-to-surgery was defined as the time between admission and surgery. Mortality data was assessed by contacting the patients by phone, mail or the national social insurance database.ResultsTwo hundred sixty patients (mean age 78 years, SD 7 years, range, 60 to 93; 172 female) were available for final analysis. Mean follow-up was 40 months (range, 12 to 68 months). Fifty-nine patients (22.7%) had died at final follow-up and 27/260 patients (10.4%) had died within 1 year after the surgery. Time-to-surgery was not different for patients who died within 1 year after the surgery and those who survived (p = .501). In-hospital complications were seen in 40/260 (15.4%) patients. Time-to-surgery showed a strong correlation with hospitalization time (Pearson’s r = .614, p < .001), but only a very weak correlation with the time spent in hospital after the surgery (Pearson’s r = .146, p = .018).ConclusionsIn contrast to patients with proximal femur factures, time-to-surgery had no significant effect on one-year mortality in geriatric patients with osteoporotic vertebral compression fractures. Treatment decisions for these fractures in the elderly should be individualized.

Incidence and Treatment Outcome of Rhinosinusitis before Kidney Transplantation: A Retrospective Cohort Study.

Background: The use of immunosuppressants after transplantation can aggravate sinus infections. Although kidney transplantation (KT) recipients are administered strong immunosuppressant therapy, there is few consensus or reports on incidence and treatment of rhinosinusitis before KT. This study was undertaken to analyze the results of a cohort of KT recipients that underwent sinonasal evaluation before KT. Methods: Observational retrospective cohort data were analyzed from adults who underwent a KT between January 2015 and December 2018. In total, 966 patients were screened by clinical history, nasal endoscopy, and plain X-ray before KT. Results: A total of 86 patients (8.9%) were diagnosed with rhinosinusitis. Twenty-three of the eighty-six patients (26.7%) who underwent plain X-ray on second follow up were successfully treated with primary and secondary antibiotics, saline irrigation, and INS. From the remaining 63 patients who underwent additional CT on second follow up, 43 patients were treated with primary or secondary antibiotics and 20 patients (10 with chronic rhinosinusitis and 10 with fungal ball) were treated with endoscopic sinus surgery. There were no serious complications affecting patient mortality after KT. Conclusion: We report that 8.9% of patients showed abnormal findings in sinonasal evaluation before KT. Although most patients did not require surgery, surgery is recommended for active rhinosinusitis, which does not respond to medication, and for fungal rhinosinusitis to prevent postoperative sinonasal infection.

Admission discipline and timing of admission may influence outcomes for gastrointestinal bleeding patients.

Bleeding of the gastrointestinal tract (BGIT) is a common gastrointestinal emergency. There is no consensus whether this condition should be admitted to medical or surgical discipline. Timing of presentation may also impact patient outcomes due to differences in healthcare resource availability. This study thus aims to investigate the impact of admitting discipline and timing of admission on patient outcomes in BGIT. A 2-year tertiary institution database was retrospectively reviewed. Outcome measures included 30-day mortality, 30-day readmissions and rebleeding requiring repeat endoscopic, angiographic or surgical interventions. Secondary outcome measures included time to endoscopy, percutaneous angiographic interventions and surgery. The effect of admission discipline (medical versus surgical) and time of admission (office-hours versus after office-hours) were analysed using a propensity-score-adjusted estimate. A total of 1384 patients were included for analysis, medical (n=853), surgical (n=530); during office-hours (n=785) and after office-hours (n=595). After propensity-score-adjusted analysis, no significant differences in mortality or readmissions were noted between medical or surgical admissions. Patients admitted under surgery were less likely to sustain rebleeding (P= 0.004) for lower BGIT and had an earlier time to endoscopy for upper BGIT (P= 0.04). Patients admitted after office-hours had similar outcomes with those admitted during office hours apart from a delay in time to endoscopy (P= 0.02). For BGIT patients, admission to a surgical discipline compared to a medical discipline appeared to have at least equivalent patient outcomes. Patients presenting with BGIT after office-hours were more likely to experience a delay to endoscopy, although it did not affect patient mortality.

Outcomes in Heart Transplant (HT) in Patients Receiving Inotropes Following UNOS Heart Allocation Policy Changes

<h3>Purpose</h3> The 2018 UNOS Heart Allocation policy changes aimed to improve stratification in patients receiving heart transplant. Patients receiving inotropes who were classified as status 1A were re-classified as status 3 following the changes. We sought to assess the effect of the 2018 UNOS Heart Allocation policy changes on patients receiving inotropes. <h3>Methods</h3> 1569 patients who required inotropes received HT in the year before and after the UNOS policy changes. Pre- (n=831) and post-policy (n=738) cohorts were identified using the UNOS registry. Baseline characteristics were compared using standard statistical analysis. 180-day outcomes were evaluated using Kaplan Meier survival analysis as well as univariate and multivariate Cox proportional hazards modeling. <h3>Results</h3> Baseline characteristics were similar for both groups regarding age, gender, ethnicity, diabetes status, smoking history, non-transplant cardiac surgery history, ventilator use, serum creatinine, PA mean pressure, and cardiac output but differed in IABP use at transplant (pre: 10%, post: 48.5%, p<0.001) and median ischemic time at less than 1, 1-2, 2-3, and greater than 4 hours, tested as a group (p<0.001). Pre-and post-policy 180-day survival was not statistically different (p=0.7391). Cox univariate hazard ratio (HR) following the UNOS change was 1.07 (CI 0.71, 1.63, p=0.739). Multivariate Cox proportional HR adjusted for age, sex, ethnicity, type 2 DM status, HLA mismatch level, total days on waitlist, and ischemic time was 1.016 (CI 0.651, 1.585, p=0.944). <h3>Conclusion</h3> UNOS policy changes were not shown to affect HT survival 180 days for patients receiving inotropes prior to transplant, however mean ischemic time and days on waiting list were increased, as well as IABP use. Further research is warranted to determine if these factors will affect patient mortality moving forward.