Cause Of Death Research Articles

Mortality due to ischemic stroke in Serbia after redistribution of the inaccurately coded deaths

Abstract Background Ischemic stroke is a major common cause of death not only in Serbia but worldwide. Mortality statistics commonly include ill-defined, impossible and insufficiently specified causes of death among the underlying causes of death (CoDs). In the activities of the Laboratory for Strengthening the Capacity and Performance of the Health System and Workforce for Health Equity, we examined mortality due to ischemic stroke either as well-defined underlying CoDs or garbage codes (GCs - including the ill-defined, unspecified or impossible CoDs) in Belgrade in 2015 and 2020. Methods Anonymous mortality data of the City Institute of Public Health Belgrade were analyzed, and the GCs were redistributed to ischemic stroke as underlying CoDs (ICD-10 codes I63-I63.9), based on the principles of the Global Burden of Disease study, using the three-step approach: 1) exploration and analysis of GCs; 2) modelling of the underlying, antecedent and immediate causes of death; 3) proportionate redistribution. Results 17% of the total of all deaths in Belgrade in 2015 and 20.9% in 2020 were GCs. Before the redistribution, the share of ischemic stroke as the well-coded CoDs of total mortality was 7.3% (1443/19641) in 2015 and 4.6% (1022/21957) in 2020. A total of GCs - 309 deaths in 2015 and 322 in 2020 were identified for redistribution to ischemic stroke. Based on the type of GCs, in 2015, a total of 139 cases were redistributed in type 1 GCs, 83 in type 2 GCs and 87 in type 3 GCs. In 2020, 141 cases were redistributed due to type 1 GCs, 62 type 2 GCs and 119 type 3 GCs. Conclusions This study underscores the significant proportion of all ischemic deaths in Belgrade that were coded with the GCs. After the redistribution, almost one-fifth of the ischemic strokes, previously known as GCs, were added, emphasizing the crucial role of accurate coding in understanding mortality patterns. Improving the coding of deaths is necessary to have reliable information for health policymaking. Key messages • One-fifth of the ischemic strokes in Belgrade were previously GCs. • Accurate coding is essential for understanding mortality patterns and developing valid health policies.

The impact of garbage codes on the quality of death coding in Belgrade in 2010, 2015, and 2020

Abstract Background Accurate data on the causes of death (CoDs) is the foundation for analyzing the health situation and developing health policy in various countries. The percentage of garbage codes (GCs) indicates the quality of the CoDs data. Within the Western Balkan Strategic Partnership Project (Work Package 4: Use of Population Health Metrics for Improved Surveillance), we evaluated the impact of the four levels of GCs on the quality of mortality data of Belgrade. Methods In a retrospective study, we examined the underlying CoDs of Belgrade residents by age and sex and the change in GCs’ share in the CoDs in 2010, 2015, and 2020. We used anonymous individual mortality data and population age and sex annual data from the electronic databases of the City Institute of Public Health of Belgrade, as well as the list of GS levels 1-4 from the 2019 Global Burden of Disease Study. Results Over the observed years, the percentage of all GCs in underlying CoDs was approximately 20%. The GCs with profound policy implications level 1 accounted for 52% of all GCs in 2020, higher than those recorded in previous years - 46.3% in 2010 and 45.1% in 2015. The total number of GCs per 100,000 inhabitants in Belgrade was the highest in 2020, with a rate of 325.2/100,000 (males: 374.4, females: 301.3). This rate has increased by about one-third since 2010 (both sexes: 245.4, males: 269.2, females: 221.1) and by about two-fifths since 2015 (both sexes: 235.8, males: 262.7, females: 211.8). Conclusions This research has revealed a significant decline in the quality of data related to the causes of death in Belgrade. One-fifth of the recorded causes of death are inaccurate or unreliable. The study highlights the importance of maintaining strict protocols for data collection, analysis, and management to ensure the accuracy and reliability of CoDs data in developing effective public health policies. Key messages • The rate of total garbage codes per 100,000 inhabitants of Belgrade has increased by about two-fifths since 2015. • Failure in quality, accuracy, and reliability of causes of death can lead to suboptimal health policymaking.

Disability during the last ten years of life: Evidence from a register-based study in Austria

Abstract Background Many older adults experience disability in activities of daily living during the last years of life, but survey-based analyses suffer from non-representative samples due to selective participation and attrition. Here, we use individual-level register data on the receipt of the Austrian long-term care allowance (ALTCA) as a proxy for late-life disability. Methods In this retrospective mortality follow-back study, we analyse receipt of ALTCA, a cash benefit based on physician assessed disability during the last 10 years of life, among all decedents aged 65 years and over from 2020 in Austria (n = 76,781). The impact of sex, age of death, and cause of death on the duration and probability of receipt of ALTCA was assessed with regression models. Results 10 years before death 10% of older men and 25% of older women received ALTCA, which increased to 27% and 51% at 5 years, 56% and 77% at 1 year, and finally to 70% and 87% at 1 month before death. On average, ALTCA was received for 3.2 years in men and 4.5 years in women. The probability to receive ALTCA and its duration increased sharply with age at death and varied by underlying causes of death: those who died from cancer, myocardial infarction, and external causes of death were less likely to receive ALTCA and experienced shorter durations of it, while those who died from dementia, Parkinson’s disease, chronic heart disease, or chronic obstructive lung disease were more likely to receive ALTCA and longer so. Conclusions Most older adults received ALTCA for multiple years before death, and this increased strongly with age at death and varied across causes of death. Our register-based estimates of late-life disability were twice as high as survey-based estimates, which points to an underestimation in previous studies. Policy-makers should be aware that costs of long-term care will likely increase as life expectancy rises and deaths from dementia and organ failure increase in ageing European societies. Key messages • A large majority of older adults in Austria experience late-life disability. On average, older men were disabled for 3.2 and older women for 4.5 years. • Probability and duration of late-life disability increased steeply with age at death and was higher for those who died from dementia, Parkinson’s disease, or chronic heart or lung disease.

Mortality and survival rate in a scottish cohort of adults with congenital heart disease

Abstract Background Adult patients with congenital heart disease (ACHD) experience higher rates of morbidity and reduced long-term survival in comparison to the general population. The care of this cohort of patients requires specialist expertise which is mainly delivered at tertiary centers. Aims We aim to report the clinical characteristics, mortality rates and causes of death in a contemporary cohort of ACHD patients followed up in a North- East Scottish Health Board. Methods We prospectively followed up ACHD patients aged ≥17 years (n=645) under review at the Regional NHS ACHD Clinic in a North- East Scottish Health Board between the years 2020 and 2023. We recorded the number and the causes of death as documented on our electronic records and on correspondence with primary care physicians. Survival analysis was performed according to the 2020 ESC Guidelines classification of congenital heart disease complexity (Table 4) classes using Kaplan-Meier method with log-rank (Mantel-Cox) test done in IBM SPSS v.24. Results Our ACHD cohort (n=645, 54% females and 46% males) included patients of all three ESC complexity classes (30% mild, 60% moderate and 10% severe). Between 2020 and 2023, 18 patients (2.8%) died, with a total incidence of 0.93 deaths/100 patient years. Median age of death was 59 years (IQR 45–71), and the majority of deceased patients were males (56%). There were 2 deaths in the mild complexity group, 11 deaths in the moderate complexity group and 5 deaths in the severe complexity group (See Table 1). This was found to correspond to an incidence of 0.34, 0.95 and 2.64 deaths/100 patient years respectively. The leading causes of death were heart failure (28%) and malignancy (22%). Using Kaplan-Meier survival analysis we found that the survival distributions for the mild, moderate and severe ACHD complexity groups were statistically significantly different by log-rank test (χ2(2) = 11.47, p < .005) (See Figure 1). Patients with moderate ACHD complexity had a median survival age 67 years (95% CI 58.1-75.9), patients with severe ACHD had median survival age 57 years (95% CI 44.7-69.2). Median survival could not be calculated for the mild group due to lack of data points. Conclusion The ACHD patient group is characterised for a variety of pathophysiology and clinical presentations. They require lifelong medical input and in spite of the local and national expertise, the mortality and morbidity rates are still high. Heart failure was the leading cause of death in this cohort which is similar to previous reported data. Mortality rates were proportional to the complexity of the underlying ACHD diagnosis. The survival rate of patients in the severe complexity group was ten years less than the moderate complex group. ACHD patients in the moderate and severe complexity groups have significantly reduced life expectancy and require access and clinical expertise from National ACHD Specialty Centers.

Escalating Health Crisis: Dissecting Mortality Causes and Trends Among Indigenous Populations in Northeast Brazil.

In Northeast Brazil, the poorest region of the country, indigenous communities face critical health care challenges. Despite legal entitlements to the Unified Health System (SUS), systemic barriers persist, exacerbating health disparities and mortality. This ecological study analyzed mortality trends and causes of death within the Special Indigenous Sanitary District (DSEI) Alagoas-Sergipe over a decade. Data on deaths from 2012 to 2022 were obtained from the Indigenous Health Secretariat. Causes of death were classified into 13 categories. Mortality rates per 1,000 indigenous inhabitants were calculated, and trends were analyzed using the Mann-Kendall test. The study also compared causes of death by age group. Mortality rates ranged from 3.3 to 5.2 per 1,000, showing a moderate upward trend over time (τ = 0.5, p = 0.042). Predominant causes included heart and vascular disorders (24.3%), external causes (12.4%), respiratory issues (11.1%), and infections (10.9%). About one-third of pediatric deaths were associated with general neonatal complications. This study highlights increasing mortality in indigenous communities in Northeast Brazil. The predominant causes of death reflect broader public health concerns. These trends emphasize the urgency for more effective, culturally sensitive public health policies and improved health care access.

Integrating AI in cause-of-death regular statistical production with human and expert system codings

Abstract Background Cause-of-death (CoD) statistics are key indicators in epidemiology and public health. These statistics are derived from death certificates completed by physicians and are usually coded by official statistics authorities according to the standards of the WHO ICD-10 classification to construct time- and cross-country-comparable statistics. For coding causes of death in free-text format in France according to ICD-10, predictions by deep neural networks (DNNs) are employed in addition to fully automatic batch coding by a rule-based expert system and to interactive coding by the coding team. Methods Seq-to-seq DNNs are trained from scratch on previously coded data to ICD-10 code multiple causes and underlying causes of death. Human coding is focused on certificates with a special public health interest or with low confidence in AI prediction quality to maximize the quality of the overall statistics disseminated when human resources are limited. DNNs also directly predict multiple causes and underlying causes of death for part of the certificates. Hence, the coding campaign aims to optimally allocate a coding mode to a given certificate. Results For deaths in 2021, 63% of the certificates are automatically batch coded by the expert system, 14% by the coding team, and 23% by DNNs. Compared to a traditional campaign that would have relied on automatic batch coding and manual coding, the present campaign reaches an accuracy of 95.7% for ICD-10 coding of the underlying cause (97.3% at the European shortlist level). Conclusions The 3-coding mode approach enables timeliness of dissemination of CoD statistics and may lead in the future to more responsive surveillance. Key messages • Deep neural networks trained on already coded data can be integrated into the regular statistical production of the CoD database in a fully controlled way. • The allocation between the different modes of coding can be optimized to achieve best quality and timeliness under the constraint of limited human resources.

Preventing unintentional injuries due to home and leisure time accidents in children: the parents’ beliefs matters (CHILD Vigilance project - CHIVI)

Abstract Background The CHILD Vigilance project is a European study supported by the Injury Prevention section of the European Public Health Association and aims at contributing to the epidemiological knowledge of injuries and accidents in Greece, Portugal and Lithuania, through increasing knowledge on parents’ and caregivers’ safety perceptions. Methods A descriptive, observational, cross-sectional study was developed in these countries between February and April 2023, under the CHILD Vigilance project. Information was collected online via a questionnaire exploring parents’ and/or caregivers’ knowledge, attitudes and risk perception towards prevention of unintentional injuries in children and adolescents. Results A total of 916 valid responses were obtained, involving 1229 children (51.4% male; mean age 7.8 years). Falls were perceived as the most common type of unintentional injuries in pre-schoolers and school-age children (47,8% in Greece; 63,5% in Portugal; 74,8% in Lithuania). Country differences were observed in terms of the most commonly perceived types of injury in adolescents, which were road traffic crashes in Greece and Portugal (41.2% and 39.5% respectively) vs poisonings in Lithuania (38.1%). Some differences were also observed between these countries as to the most common causes of death. In Greece and Lithuania diseases were reported as the main cause of death in pre-schoolers (62.5%; 35.1%) and in children attending primary education (55.1%; 29.7%), while injuries were identified as a cause only in the oldest group of children. In Portugal on the other hand, injuries were identified as the most frequent cause of death in all groups, pre-schoolers (40.5%), children attending primary education (47.1%) and in the oldest (55.1%). Conclusions The study emphasizes the need to address misperceptions, improve safety attitudes and invest more efforts in managing harmonised injury outcomes across global initiatives.

Multi-centre post-mortem study on the use of coronary inflammation in CCTA to improve the diagnosis of the coronary related cause of death with histopathology validation

Abstract Background/Introduction A limitation of post-mortem computed tomography (PMCT) is the diagnostic accuracy of coronary related death, which constitute majority of investigations. Measurements using coronary inflammation with fat attenuation index (FAI) Score, clinical risk factors and coronary plaque metrics from CCTA to predict fatal cardiac events (AI-Risk) in living patients has not been used in post-mortem setting. Purpose This study investigates two new techniques to aid the diagnosis of coronary related death in the post-mortem setting: (1) minimally invasive interventional technique to perform PMCT; (2) diagnostic accuracy of FAI-assisted PMCT with histopathology validation. Method Adults with sudden death of unknown cause <48 hours from death were included. Ultrasound guided femoral access to deliver guidewire to the aortic root (Figure 1A), followed by inflation of aortic occlusion balloon and injection of contrast for angiogram. A cardiac radiologist performed the coronary and FAI analysis (1B &C). Two experienced radiologists reported the cause of death without/with aid of FAI score results. The technique was introduced at a second PMCT centre. Results PMCT analysis of 37 participants (27 males, 10 females, age range 42-98) – 15 minimally invasive PMCT, and 22 PMCT from previous study showed FAI score (1D) and AI-Risk (1E) were significantly higher in participants who had coronary related death vs non-coronary related causes. In the receiver operating characteristic (ROC, 1F) analysis, thresholding at 42% for AI-Risk and 34 for Mean FAI score, was able to detect all 18 true positives, 2 false positives (1xpulmonary embolism, and 1xdual pathology of ruptured abdominal aneurysm with severe coronary artery disease; these cases showed high FAI score and AI-Risk), and all true negatives. Both radiologists identified 17/18 coronary related death. There were 5 cases of false positives for coronary related death in Radiologist 1 (3 years’ experience); 8 false positives in Radiologists 2 (10 years’ experience). In non-coronary related deaths, Radiologist 1 identified 14/19 true negative cases, and Radiologist 2 identified 11/19 true negative cases. In all the false positive and negative cases, the radiologists’ diagnostic confidence level was either possible, or unascertain. With the aid of FAI score results, all the true coronary related deaths were identified and no false negative case. This method was introduced at a second centre with 108 PMCTs analysed. There were 40 cases of non-coronary death, and 68 cases of coronary related death on PMCT (imaging diagnosis only). In the non-coronary group, FAI-score assisted results showed 100% concordance. In the coronary group, there was 10% dis-concordance (7/68). Conclusion Minimally invasive PMCT with FAI score-assisted diagnosis has the potential to increase the diagnostic confidence and accuracy of coronary-related cause of death.

Causes of death in people living with HIV: Lessons from five health facilities in Eswatini

Background: Eswatini has a high HIV prevalence in adults and, despite being one of the first countries to achieve the UNAIDS 95-95-95 targets, AIDS-related deaths are still high.Objectives: This study describes the causes of death among people living with HIV (PLHIV) receiving care at five clinics in Eswatini.Method: A cross-sectional review of sociodemographic, clinical and mortality data of deceased clients who received care from 01 January 2021 to 30 June 2022, was conducted. Data were extracted from the deceased clients’ clinical records, and descriptive and comparative analysis was performed.Results: Of 257 clients, 52.5% (n = 135) were male, and the median age was 47 years (interquartile range [IQR]: 38, 59). The leading causes of death were non-communicable diseases (NCDs) (n = 59, 23.0%), malignancies (n = 37, 14.4%), COVID-19 (n = 36, 14.0%), and advanced HIV disease (AHD) (n = 24, 9.3%). Clients who had been on antiretroviral therapy (ART) for 12–60 months (OR: 0.01; 95% confidence interval [CI]: 0.0006, 0.06) and 60 months (OR: 0.006; 95% CI: 0.0003, 0.029) had lower odds of death from AHD compared to those on ART for 12 months. Clients aged ≥ 40 years had higher odds of dying from COVID-19, while female clients (OR: 2.64; 95% CI: 1.29, 5.70) had higher odds of death from malignancy.Conclusion: Most clients who died were aged 40 years and above and died from NCD-related causes, indicating a need to integrate prevention, screening, and treatment of NCDs into HIV services. Specific interventions targeting younger PLHIV will limit their risk for AHD.

Distal ascending aortic dilatation portends a near 2-fold greater risk of cardiovascular mortality than proximal enlargement: results from 120,000 patients in a nationwide echocardiographic database

Abstract Background The management of thoracic aortic dilatation is clinically challenging and acute aortic dissection (AD) is under-recognised as a primary cause of death. Despite the majority of AD occurring in non-severely dilated aortas, absolute aortic diameter remains the most utilised criterion for adjudging preventative surgical correction. In order to improve outcomes and guide management, greater prognostic understanding is needed. Purpose We examined a nationwide echocardiographic dataset linked to mortality outcomes to determine how ascending thoracic aortic dilatation and its site affects cardiovascular disease (CVD) mortality over time. Methods The National Echocardiography Database Australia (NEDA) was examined for aortic dimensions at the sinuses of Valsalva (SoV), sinotubular junction (STJ) and ascending aorta (AscAo) in patients who had undertaken >1 echocardiographic study. Following separation of those who had undergone corrective aortic surgery, patients were stratified according to absolute aortic diameters and grouped as normal (<4cm), mild (4.0-4.5cm), moderate (4.5-5cm) and severely (>5cm) dilated at the prescribed thoracic aortic sites. Mortality data was then linked from the National Death Index (NDI). Results 398,905 echocardiographs from 121,115 patients with a mean age of 62.6±16.2 years were included. At the time of mortality data linkage, 38,681 (32%) had died, of whom 13,292 (34%) died from CVD causes and only 276 (0.007%) had aortic dissection recorded as their primary cause of death. Severe aortic dilatation at any site increased the likelihood of 10-year CVD mortality (29% vs. 15% in those with normal diameters; HR 3.00; CI 1.60-5.63; p<0.0001), with an incremental increase in the probability of CVD death when moving from the proximal to distal ascending aorta; 10-year CVD mortality at the SoV 26% (HR 1.93; CI 1.29-2.87; p<0.001), STJ 39% (HR 2.82; CI 1.64-4.86; p<0.001) and AscAo 44% (HR 4.74; CI 2.46-9.13; p<0.001) respectively (Figure 1). When examining those patients who had undergone corrective aortic surgery, the likelihood of 10-year CVD mortality was comparable to the population with normal aortic diameters (17 vs. 15%, HR 1.1; CI 0.9-1.36; p=0.3) (Figure 2). Conclusion Severe aortic dilatation increases the probability of 10-year cardiovascular mortality. Interestingly, there is an incremental increase in the likelihood of CVD mortality when moving from the proximal to distal ascending aorta, with severe AscAo dilatation conferring a near 2-fold greater risk of CVD mortality compared with severe SoV aneurysms. Additionally, surgical aortic intervention nearly normalises survival probability to the population with healthy aortic diameters. These results identify new considerations for prognostication, risk stratification and surgical guidance of aortic repair.CVD mortality by aortic dilatationCVD mortality after aortic intervention

Trends in diabetes morbi-mortality and its association with abdominal obesity among Tunisian adults

Abstract Introduction Tunisia is undergoing rapid nutritional transition, with increasing rates of abdominal obesity. Coupled with rising diabetes prevalence, it poses significant challenges to public health. This study aimed to estimate the morbi-mortality prevalence and trends of diabetes among Tunisian adults, particularly examining its association with abdominal obesity. Methods We conducted a secondary data analysis on adults aged 35 to 70 from three national surveys in Tunisia, in 1996 (n = 3513), 2005 (n = 7700), and 2016 (n = 6007) respectively. Mortality data was sourced from the Tunisian National Information System on Causes of Death in 2020. The underlying cause of death was determined using the IRIS software, following WHO guidelines for tabulating mortality statistics. Diabetes was defined according to the American Association of Diabetes criteria. Abdominal obesity was defined as a waist-to-height ratio ≥ 0.6. We performed chi-squared test for trend analysis. Results A total of 17220 participants were analyzed. We found a significant upwards trend in diabetes prevalence (p < 10-3): it increased from 13.1%[11.9-14.3] in 1996 to 15.1% [12.5-17.4] in 2005, then to 20.5%[18.9-22.1] in 2016. Linear trend test concluded to significant increase in diabetes prevalence estimated at 56.6% in two decades. Diabetes was significantly associated with abdominal obesity (Odds ratio (OR)=2.17[2.11-2.21]). Diabetes was the leading cause of death among Tunisian adults in 2020 (n = 22715). The proportional mortality due to diabetes was estimated at 6.2% (n = 1407) (6.4% for men and 6% for women). The age group with the highest proportional mortality due to diabetes was 65-70 years old (44.6%). Conclusions Our findings highlight the burden of diabetes on public health in Tunisia and its association with abdominal obesity. Hence the urgency to strengthen comprehensive preventive and control measures to alleviate its repercussions among the Tunisian population. Key messages • The prevalence of diabetes increased significantly amongTunisian adults in the past two decades. • Immediate implementation of targeted interventions and policy measures is imperative to effectively address this issue.

Effects of restrictive vs liberal transfusion strategies on mortality in patients with acute myocardial infarction and anemia: The 6-month follow up primary results of the MINT trial

Abstract Background The Myocardial Ischemia and Transfusion (MINT) trial identified a statistically non-significant increase in risk of 30-day death or myocardial infarction (MI) (primary endpoint) and all-cause death and a statistically significant increase in cardiac death in patients with an acute MI and anemia assigned to a restrictive transfusion strategy compared to a liberal transfusion strategy. Purpose To determine the effect of a restrictive versus a liberal transfusion strategy on all-cause and cause-specific death 6-months post-randomization (secondary endpoint). Methods The MINT trial randomized 3,504 patients with MI and hemoglobin <10 g/dL to a restrictive (hemoglobin threshold of 7 or 8 g/dL) or liberal (hemoglobin threshold of <10 g/dL) transfusion strategy implemented during the index hospitalization. Sites contacted patients at 30-days and 6-months post-randomization and recorded patient vital status, date of death, and site-reported cause of death (categorized as cardiac, non-cardiac, or unknown). A competing risk analysis (cumulative incidence estimation and Fine-Gray models) was conducted to estimate the effect of transfusion strategy on all-cause and cause-specific death. Results Patients were enrolled from 6 countries between 2017 and 2023; average age was 72 years, and 46% were female. Vital status at 6-months was obtained for 3419 (97.6%) randomized patients (restrictive: 98.1%; liberal: 97.0%); 2,690 (76.8%) patients were alive and 729 (20.8%) had died. At 6-months, all-cause death occurred in 376 patients in the restrictive arm (21.7%) and 353 in the liberal arm (20.5%), hazard ratio [HR]: 1.07, 95% CI: 0.93–1.24. Compared to the liberal arm, a greater proportion of deaths in the restrictive arm were cardiac (41.8% vs. 29.8%). The risk of cardiac death was significantly higher in patients in the restrictive arm (9.0% vs. 6.1%, HR: 1.52; 95% CI: 1.19–1.94) whereas risk of non-cardiac death (HR: 0.87; 95% CI: 0.70–1.08) and unknown cause of death (HR: 0.88; 95% CI: 0.64–1.21) did not differ between the restrictive and the liberal arms. Conclusions In patients with acute MI and anemia, the 6-month incidence of all-cause death did not differ with a restrictive versus a liberal transfusion strategy. However, the numerically higher rate of all-cause mortality, seen with the restrictive strategy at 30-days, persisted through 6-months and was driven by cardiac causes. The long-term findings from the MINT trial suggest that a restrictive transfusion strategy may be harmful for patients with MI and anemia.

Pediatric cancer mortality: Analyzing early deaths and fatalities in a resource-limited tertiary care context.

Children with suspected cancer may succumb to their bad condition shortly after admission, even before a definitive diagnosis can be reached. We aimed to address the issue of delayed presentation and early deaths among children suspected of having cancer. We analyzed also the types and causes of mortalities across different tumor types. A retrospective review of reports from newly admitted patients between 2006 and 2010 at the pediatric oncology department of the South Egypt Cancer Institute (SECI) was done. Parameters included age, gender, diagnosis, symptoms, the interval between initial symptoms and the first visit to SECI, the duration from admission to death, and the cause of death. Among the 502 patients with confirmed malignancies, 238 (47.4%) succumbed. Causes of death were predominantly treatment-related mortalities (TRM) (66%). Mortalities within hematological malignancies were mainly TRM (81%), whereas solid tumors were primarily disease-related (70%), p <0.0001. The leading causes of TRM was infection (60%). About 5% of patients experienced early death within 48 hours after presenting to SECI. The mean duration from initial symptoms to the first SECI visit was 67 days, and the period from admission to death averaged 27 hours. Common initial symptoms included abdominal swelling (29.6%), or fever (26%). The leading causes of death were respiratory failure (29.6%), tumor lysis syndrome (22%), or septicemia (22%). Delayed presentation leading to early deaths poses a significant obstacle to the successful treatment of childhood cancers. Early diagnosis and improved supportive care are essential to enhancing the overall survival, particularly in patients with hematologigical malignancies.

Periprocedural complications during transvenous lead extraction. Lessons learned from the GermAn Laser Lead Extraction RegistrY (GALLERY)

Abstract Background Transvenous lead extraction (TLE) has become an established therapy for patients with cardiac device-related complications such as infection or lead dysfunction. Although safe and effective, periprocedural complications such as vascular or cardiac lacerations with the need for major surgical intervention occur and lead to morbidity and mortality. Objective &amp; Methods The aim of this study was to conduct a retrospective analysis of the incidence, management and outcome of all major complications suffered by patients undergoing TLE in the GALLERY and to compare patient characteristics, procedural data and outcome against patients who suffered minor or no periprocedural complications. We performed multivariate regression analysis to identify independent predictors for death in patients with major complications. Results We identified 52 patients with major (Group A), 57 patients with minor (Groups B) and 2415 patients with no periprocedural complications (Group C) undergoing TLE in the GALLERY (2.1%, 2.3% and 95.7% of total patients, respectively). There were no differences in age (67.4±14.0 vs. 66.6±13.5 vs. 68.1±13.8 years; p=0.612), body mass index (BMI – 26.5±5.4 vs. 26.1±4.2 vs. 27.1±4.7 kg/m2; p=0.140) or other comorbidities, such as arterial hypertension or chronic kidney disease (CKD), except for more patients with diabetes mellitus (15.4 vs. 42.1 vs. 31.3%; p=0.01) in Group B and a trend towards less patients with previous cardiac surgery (15.4 vs. 35.1 vs. 24.2%; p=0.053) in Group A. Mean number of leads per patient were 2.5±1.1, 2.4±1.0 and 2.4±1.0 (p=0.645). Most common minor complication was pocket hematoma in 82.6% of cases. Laceration of the superior vena cava (SVC – 40.4%) was the most common major complication, followed by perforation of the right atrium (RA – 23.1%). Emergent median sternotomy was necessary in 80.8% of cases in Group A, of which 67.4% required cardiopulmonary bypass. Clinical success for TLE could only be achieved in 63.5% of cases in Group A, whereas Groups B and C achieved 100.0 and 98.5% (p&amp;lt;0.001), respectively. The mortality rate in Group A was 28.9%, in contrast to 5.3% and 3.0% in Groups B and C (p&amp;lt;0.001), which translates into a procedure-related mortality of 0.6% for the entire GALLERY. Septic shock was the most common cause of death in all groups (7.7 vs. 3.5 vs. 1.9%, p=0.013). Multivariate regression analysis revealed CKD (OR:4.7, 95%CI: 1.06-20.7, p=0.04) and previous cardiac surgery (OR:6.3, 95%CI: 1.2-33.6, p=0.03) as independent predictors for death in patients who suffered a major complication during TLE. Conclusion Although rare, TLE remains a procedure with potential for major complications such as lacerations of the SVC or perforation of the RA. Immediate availability of emergent surgical intervention ensures a survival rate of 71,1%. Previous cardiac surgery and CKD seem to be independent predictors for death in such patients.

Clinical profile and outcomes of patients with chronic kidney disease on chronic hemodialysis hospitalized for acute coronary syndrome in a tertiary public hospital in the Philippines

Abstract Introduction Acute coronary syndrome (ACS) and end-stage renal disease (ESRD) are both prevalent globally. Of the many risk factors for ACS, chronic kidney disease (CKD) remains to be of great concern because the interplay of cardiac and renal disease is inherently complicated. Cardiovascular mortality rates are 10-30 times higher in the ESRD population. The risk for cardiovascular disease in CKD extends beyond the traditional risk factors. Purpose The guidelines for ACS may not be applicable to the ESRD population because the landmark ACS trials mostly excluded ESRD patients. Due to the gaps in knowledge regarding ACS in ESRD, our study sought to explore the clinical profile and outcomes of these patients in the our institution. Methods We did a retrospective cohort study among ESRD patients presenting with ACS in our institution from May 2021 to November 2023. The data was analyzed using univariate and bivariate statistics using PRISM software. Results A total of 48 patients with ESRD were admitted for ACS in this study - 8 with STEMI and 40 with NSTEMI. The mean age was 61 years old and 33 (68.8%) were male. The average length of hospital stay was 12 days. The most common comorbidities were hypertension (91.7%), heart failure (83.3%), and diabetes mellitus (60.4%). The most common cause of ESRD in our cohort is concomitant hypertensive and diabetic kidney disease (45.8%) with an average length of hemodialysis at 31 months. The most common chief complaints were chest pain (39.6%), dyspnea (29.2%), and decreased sensorium (10.4%). On admission, 18 (37.5%) presented with systolic BP &amp;gt;160mmHg, 7 (14.6%) presented with shock, and 4 (8.3%) presented with cardiac arrest. On electrocardiogram, 21 (43.8%) had left ventricular hypertrophy while 34 (70.8%) had cardiomegaly on chest radiography. On two-dimensional echocardiogram, the average left ventricular ejection fraction was 46% and 27 (90%) had segmental wall motion abnormalities. The most common angiographic finding was 3-vessel coronary artery disease (50%). Only 5 patients (10.4%) had an LDL-C greater than 55mg/dL. Among those with STEMI, 6 (75%) presented with Kilip II or more. While among those with NSTEMI, 27 (67.5%) had a TIMI risk score &amp;gt;2. Almost all patients received dual-antiplatelet therapy, high dose statin, and beta-blocker. The mortality rate was 43.8% with acute coronary syndrome being the most common cause of death. Conclusion Our study did not show significant associated predictors of mortality possibly due to the low sample size. Despite this, our study portrays that patients admitted for ACS with ESRD present with higher risk features reflected by derangement in vital signs, abnormal laboratories, significant imaging abnormalities, high prognostication scores, and high in-hospital morbidity.Predictors of Mortality

Children after kidney transplantation show severe cardiac alterations

Abstract Sudden cardiac death is among the most common causes of death in patients with chronic kidney diseases (CKD) after pediatric kidney transplantation (KTx), but defined diagnostic procedures identifying children at risk are not established. Echocardiographically detectable damage in the context of CKD has been described, but there are few data after KTx in childhood. The aim was to characterize structural and functional cardiac alterations on cardiac MRI (cMRI) and echocardiography in children after KTx and to elucidate the significance of diastolic dysfunction in this special context. 46 KTx recipients (mean age 16.0±3.5 years) and due to missing reference values 46 age- and sex-matched healthy controls were examined with non-contrast cMRI. Native T1 time (nT1), left ventricular mass z-score (LVMIz), ejection fraction (EF), global longitudinal strain (GLS) were measured. KTx recipients underwent comprehensive echocardiography: EF, mitral inflow (E-, A-wave), TDI e', E/e'-ratio, isovolumetric relaxation time (IVRT), pulmonary venous flow (PVFsys, PVFdia), atrial reversal (PVF-AR) and left atrial volume index (LAVI), left ventricular mass z-score (LVMz). Multivariable linear regression analysis (co-variates: age, sex, height) were used to show associations between cMRI and echo parameters. In cMRI KTx recipients had a siginficant higher nT1 than healthy controls (septal: 1198±49ms vs. 1155±23ms, p&amp;lt;0.0001; lateral: 1141±57ms vs. 1109±37ms, p=0.003). In KTx recipients, LVMIz was higher (0.1±1.1g/m2 vs. -0.3±0.7g/m2; p=0.026), GLS was lower than in healthy controls (-19± 2.1% vs. -20.3±2.7%, p=0.01). While based on cMRI 2 patients were diagnosed with left ventricluar hypertrophy (LVH), 11% (n=5) displayed LVH on echo. EF was preserved in all patients. However, in echocardiography, 90% (n=40) of the KTx recipients showed diastolic parameters out of the age-specific normal range (Fig.1) with changes in two or more diastolic parameters in half of the cohort. Associations with septal nT1 on cMRI could be demonstrated for septal E/e´ (ß=8.415, p=0.042), A-wave (ß=1.037, p=0.045), LAVI (ß=3.347, p=0.002) and PVF-AR (ß=2.945, p=0.021); associations with lateral nT1: septal E/e´ (ß=9.590, p=0.045) and LAVI (ß=3.393, p=0.009) (Fig. 2); 7 (15 %) had an elevated nT1 septal, lateral and E/e´ out of the normal range. Young KTx recipients show a high prevalence of diastolic dysfunction with preserved EF. Impaired diastolic function was associated with structural alterations reflecting myocardial fibrosis. Our findings suggest that a large number of children after KTx suffer from heart failure with preserved EF – an entity not yet defined in children but described for adults, in whom it is associated with sudden cardiac death. Further studies are needed to describe the clinical relevance of these findings, which gain explicit importance, as the prognosis of HFpEF in adults is improved by SGLT2i, a treatment option not yet considered in our high-risk patient group.

Management and outcomes in pulmonary arterial hypertension patients with sepsis

BackgroundSepsis is a common cause of death in patients with pulmonary arterial hypertension (PAH). Treatment requires careful fluid management and hemodynamic support. This study compares patients with or without PAH presenting with sepsis with a focus on initial fluid resuscitation.MethodsThis retrospective analysis compared adults with and without PAH admitted for sepsis at two academic hospitals between 2013 and 2022. Prior PAH diagnosis was verified by review of right heart catheterization data and sepsis present on admission was verified by chart review. Demographics, vital signs, laboratory values, imaging results, treatment approaches, and all-cause mortality data were obtained. Controls were propensity score weighted by age, sex, and Charlson Comorbidity index. Logistic regression models controlling for age and Charlson comorbidity indices were used to examine factors associated with survival.ResultsThirty patients admitted for sepsis with pre-existing PAH were compared to 96 matched controls. Controls received significantly more fluids at 24 h compared to PAH patients (median 0 mL v. 1216 mL, p < 0.001), while PAH patients were more likely to receive vasoactive medications (23.3% vs. 8.3%, p = 0.037). At 30 days, 7 PAH patients (23.3%) and 13 control patients (13.5%) had died (p = 0.376). PAH patients that received more fluids had decreased mortality (OR 0.31, 95% CI 0.11–0.92, p = 0.03) and patients who received fluids had shorter mean time to antibiotics (2.3 h v. 6.5 h, p = 0.04), although decreased time to antibiotics was not associated with mortality. Patients who received no fluids more often had previously identified right ventricular systolic dysfunction (62.5% v. 28.6%, p = 0.136).ConclusionPatients with PAH and sepsis have high mortality and receive different treatments than controls, with more reliance on vasopressors and less on fluid resuscitation. PAH patients who received less fluids had higher mortality and those who received no fluids had a longer time to receiving antibiotics, indicating a potential delay in recognizing sepsis. Timely recognition of sepsis and dynamic decision-making around fluid resuscitation remains critical in this high-risk population.

Survival and predictors of mortality in patients with heart failure in the cardiology department of the Center Hospitalier Basse Terre in Guadeloupe: historical cohort study

BackgroundDespite the progress made in recent years in the treatment of Acute Heart Failure (AHF), its prognosis remains poor in the developing country. The objective of this study is to analyze the survival and predictors of mortality of patients with acute heart failure in the cardiology department of the Basse Terre Hospital Center in Guadeloupe.Methodsthis was a historical cohort study carried out over a period from June 2021 to June 2022, targeting all acute heart failure patients undergoing cardiac monitoring in the cardiology department of the Basse Terre Hospital Center in Guadeloupe. Sociodemographic, clinical, biological characteristics and outcome (recovery or death) were studied. Survival was described using the Kaplan Meier method α = 5%.Resultsthis study involved 242 acute heart failure patients whose median age was 75 years and the majority were male (sex ratio 2 M/1F). Among these patients, 14.9% died, the most common cause of death was cardiogenic shock (52.8%). After adjustment, tobacco consumption (aHR: 2.90; 95% CI: 1.36–8.09), Chronic Kidney Disease (aHR: 2.52; 95% CI: 1.22–5.20), infection (aHR: 2.14; 95CI %: 1.99–4.58), hyponatremia (aHR: 1.90; 95% CI: 1.10–2.86), mitral regurgitation (aHR: 3.04; 95% CI: 1.98–9.47) and N-terminal pro Brain Natriuretic Peptide > 10000ng/ml (aHR: 2.57; 95% CI: 1.21–5.49) were independently associated with the risk of death in heart failure patients.ConclusionAcute heart failure leads to high mortality, mainly due to cardiogenic shock and factors of multiple organ failure.

The admission inflammatory biomarkers profile of elderly hip fractures and its association with one-year walking independence and mortality: a prospective study.

Immune response plays an important role in the regulation of elderly hip fracture. This study aims to analyze the relationship between systemic inflammatory markers including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) and mortality and walking independence, providing valuable references for the postoperative management of geriatric hip fracture. A retrospective analysis of prospective data on elderly patients who have undergone hip surgery and have been followed for at least one year. The receiver operating characteristic (ROC) curves and the optimum cutoff value were calculated. Univariate analysis and multivariate logistic regression analysis were used to identify the associations between admission four systemic inflammatory markers and one-year mortality and locomotion recovery. During the study period, respiratory disease was the most common cause of death, followed by cardiovascular disease. Multivariate analysis identified NLR (OR, 1.13; 95%CI: 1.09-1.17), SIRI(OR, 1.18; 95%CI: 1.08-1.28) and advanced age (OR, 1.06; 95%CI: 1.01-1.11) as independent risk factors for one-year mortality. In addition, 89 (rate, 31.8%) survivors had poor walking independence within one year. NLR (OR, 1.37; 95%CI: 1.26-1.50), SII(OR, 1.00; 95%CI: 1.001-1.003), SIRI(OR, 1.36; 95%CI: 1.18-1.57) and advanced age (OR, 1.08; 95%CI: 1.02-1.13) were associated with postoperative locomotion recovery. In summary, admission NLR and SIRI are correlated with a high risk of one-year walking independence and mortality, providing a basis for the clinical management of geriatric hip fractures.

Preventing unintentional injuries in children: the parents’ beliefs matters (CHILD Vigilance)

Abstract The CHILD Vigilance project is a European study supported by the Injury Prevention &amp; Safety Promotion Section of the European Public Health Association (EUPHA INJ) and aims at assessing parenting knowledge and attitudes that are relevant to supervision and risk taking in children. For children the majority of these injuries occur in or around the home when their safety is the responsibility of a parent or other caregiver. The study aims contribute to the epidemiological knowledge of injuries through the study of the perceptions of parents and caregivers of children and adolescents. A descriptive, observational, cross-sectional study was developed under the CHILD Vigilance project, developed at European level within the scope of the Injury Prevention &amp; Safety Promotion Section of the European Public Health Association. The information was collected by survey, from parents’ associations and schools in the EU countries represented in the EUPHA INJ Section. A total of 916 valid responses were obtained, involving 1229 children (51,4% male; mean age 7,8 years). Falls were perceived as the most common type of unintentional injuries in pre-schoolers and school-age children (47,8% in Greece; 63,5% in Portugal; 74,8% in Lithuania). However it was found differences in these countries as to the most common type of injury in adolescents, pointing out road traffic crashes (41.2% in Greece vs 39.5% in Portugal) and poisonings in Lithuania (38,1%). Some differences were also observed between these countries as to the most common causes of death. In Greece and Lithuania diseases were reported the main cause in the pre-schoolers (62,5%; 35,1%) and in primary education (55,1%; 29,7%), being injuries pointed as the most frequent cause only in the oldest. The study emphasizes the need to invest in the identification of appropriate determinants of child unintentional injuries and harmonised injury outcomes across global initiatives. Key messages • The lack of data regarding to parents’ knowledge on injury prevention involving children highlight the need to conduct this type of studies. • The need for adequate epidemiological data on the burden of child injuries and validated tools to accurately measure injuries.