Charlson Comorbidity Index Values Research Articles

P-2123. Unveiling Mortality Patterns in Candidemia: Insights from a Multi-Species Analysis from a Global Research Network

Abstract Background Candidemia remains a critical concern in healthcare settings due to its high mortality rates and increasing prevalence of multidrug-resistant strains. Understanding the impact of different Candida species on patient outcomes is crucial for effective management and treatment strategies. This study aims to comprehensively analyze the association between Candida species and mortality in candidemia cases. Percentages of 1-year mortality by Candida species. Methods We queried TriNetX, a global research network database (https://trinetx.com/), to identify patients with positive candidemia in blood by PCR testing from 2020-2023. We captured mortality as the primary outcome at one year in patients with candidemia categorized by Candida species. The time to death within the one year period was assessed using Kaplan-Meier plots, along with the non-parametric log-rank and Peto-Peto tests. Additionally, Cox proportional hazards (PH) models, both unadjusted and adjusted for demographic and comorbidity covariates, were employed for comparative analysis. Unadjusted Kaplan-Mier Survival analysis with failure estimates in candidemia by Candida species Results We captured 1,233 candidemia episodes during the study period. The distribution of Candida species was C. albicans (498, 40.4%), C. glabrata (333, 27%), C. auris (151, 12%), C. parapsilosis (121, 9.8%), C. tropicalis (59, 5%), C. krusei (28, 2%), and poly-candidemia (44, 4%) (Table 1). The one-year mortality varied across species, ranging from 15.3% to 36.6% (Figure 1). The unadjusted Kaplan-Mier Survival analysis showed that poly-candidemia, followed by C. tropicalis, had a worse survival than C. auris, which had the lowest risk (Figure 2). Adjusted Cox PH model found C. albicans, C. glabrata, C. parapsilosis, C. tropicalis, and poly-candidemia had statistically significantly higher mortality rates than C. auris. Additionally, age, non-Hispanic ethnicity, residence in the Western US region, and a higher Charlson comorbidity index value emerged as independent predictors of increased mortality (Table 2). Clinical features by Candida species Conclusion Among patients with candidemia, we found an overall 1-year mortality of 28%. The associated resistance of C. auris may translate into a decreased virulence and a survival advantage. Additionally, older age and a higher comorbidity burden were associated with 1-year mortality. Disclosures George R. Thompson, III, MD, Astellas: Advisor/Consultant|Cidara: Advisor/Consultant|Cidara: Grant/Research Support|F2G: Advisor/Consultant|F2G: Grant/Research Support|Melinta: Advisor/Consultant|Melinta: Grant/Research Support|Mundipharma: Advisor/Consultant|Mundipharma: Grant/Research Support|Pfizer: Advisor/Consultant

To analyze the risk factors associated with mortality within 1 year after surgery in elderly patients with hip fracture and to assess the value of the age-corrected Charlson comorbidity index in predicting this mortality risk.

To investigate the determining risk factors for 1-year postoperative mortality in elderly patients with hip fracture and to assess the efficacy of the age-adjusted Charlson comorbidity index (ACCI) in predicting the risk of death. This study adopted a retrospective analysis method to focus on 652 elderly patients who underwent hip fracture surgery between January 2018 and November 2022 in our hospital. By systematically combing the patients' medical records, relevant data were collected and analyzed in depth for their association with morbidity and mortality rates within 1 year. In the 1-year follow-up for 652 elderly patients who underwent hip fracture surgery, the proportion of deaths due to disease amounted to 21.5% (140/652). Univariate analysis using the Cox proportional hazard model revealed that age, number of hospital days, ACCI, and the occurrence of postoperative pneumonia were significantly associated with the rate of morbidity and mortality within 1 year. Further multivariate Cox regression analysis confirmed that age (hazard ratio [HR], 1.087 [95% confidence interval [CI], 1.060-1.114]), ACCI (HR, 1.645 [95% CI, 1.548-1.747]), and postoperative pneumonia (HR, 2.353 [95% CI, 1.624-3.408]) served as independent risk factors that significantly influenced the patients' 1-year survival. The ACCI excelled in predicting the risk of 1-year postoperative mortality, with an AUC of 0.912 for its prediction model and a specificity and sensitivity of 0.834 and 0.871, respectively, when the threshold was set at 5.5. The results of this study emphasize that age, ACCI, and postoperative pneumonia are key risk factors affecting the survival of elderly patients with hip fracture at 1-year postoperatively. ACCI, as an effective predictive tool, can provide an important reference for the clinical assessment of patients' postoperative risk and help precision medical decision-making.

The Prognostic Value of Systemic Immune-Inflammation Index Supporting Age-Adjusted Charlson Comorbidity Index in Non-Small Cell Lung Cancer Patients with First-Line Platinum-Based Chemotherapy.

This study aimed to examine the association between the systemic immune-inflammation index (SII) (ie, neutrophil count × platelet count/lymphocyte count), the age-adjusted Charlson comorbidity index (ACCI), and overall survival (OS) in non-small cell lung cancer (NSCLC) patients undergoing first-line platinum-based chemotherapy (PBC), with a particular emphasis on the role of SII in supporting ACCI. This retrospective study enrolled 353 cases treated between July 2013 and November 2020. Mann-Whitney U-test and Kruskal-Wallis test were employed to compare parameters between high and low SII groups. The cut-off values for SII and ACCI were determined using the X-tile software. Prognostic significance was evaluated through the utilization of Kaplan-Meier curves and Cox regression analysis. In a univariate Cox regression analysis, sex, age, TNM, lymph node, therapy, SII, and ACCI were associated with OS. After adjusting for confounders in the multivariate analysis, TNM, SII, and ACCI remained independent prognostic factors for OS. Furthermore, within the ACCI subgroups (ACCI<5 or ACCI≥5), a high SII was significantly associated with an increased risk of death. Patients with both a high ACCI and a high SII had the highest risk of death (p < 0.001), with a loss of approximately ten months of survival during the first three years after treatment. SII was proven to be valuable in predicting OS and, when complemented by ACCI, can help tailor prognostic assessment and treatment strategies in assessing the survival of NSCLC patients with first-line PBC.

Clinical Insights and Outcomes in Community-Acquired Acute Bacterial Meningitis versus Postoperative Bacterial Meningitis.

To compare the demographics, clinical characteristics, and in-hospital mortality rates between community-acquired bacterial meningitis cases and postoperative bacterial meningitis. Analytical study. Place and Duration of the Study: Department of Infectious Diseases and Clinical Microbiology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkiye, from 2016 to 2022. A total of 153 patients diagnosed with bacterial meningitis were included and categorised into two groups: 95 (62.1%) with community-acquired bacterial meningitis (CABM) and 58 (37.9%) with postoperative bacterial meningitis (POBM). Demographics, clinical features, laboratory, paraclinical findings, treatments, and outcomes of the cases were compared. Data were retrieved using a standard data collection form from the electronic medical records. A substantial portion (58.8%) of all patients had comorbidities. Fever was the common symptom in all groups. Headache, neck stiffness, nausea, and vomiting were more often observed in the CABM group (p <0.001). Upon admission, the CABM exhibited higher levels of white blood cell count, C-reactive protein, and procalcitonin (p = 0.017, p = 0.004, p = 0.007, respectively). Overall 33.1% had positive cerebrospinal fluid cultures. The overall mortality rate was 26.8%. POBM was associated with longer hospital and intensive care unit (ICU) stays (p <0.001). Shorter treatment durations, lower Glasgow coma scale scores (GCS), higher Charlson Comorbidity Index values, and elevated markers of inflammation were related to mortality. This study illuminates the differences in clinical presentations and outcomes between community-acquired and postoperative bacterial meningitis. It also suggests that factors such as lower GCS scores, comorbidities, and elevated inflammation markers at the last follow-up may be associated with unfavourable clinical outcomes in bacterial meningitis. Postoperative meningitis, Central nervous system infection, Cerebrospinal fluid, Antibiotics.

New Surgical Criteria for Intraductal Papillary Mucinous Neoplasm Based on the Age-Adjusted Charlson Comorbidity Index Values and Presence of Solid Component.

Objectives: The present study aimed to validate the new international guidelines for IPMN and determine the surgical criteria for patients with IPMN exhibiting high-risk stigmata (HRS). Methods: We enrolled 115 IPMN patients exhibiting HRS who were diagnosed between 2004 and 2021. Of the 115 patients, 79 underwent surgery (surgical group) and 36 did not undergo surgery (non-surgical group). The overall survival (OS) of each group was compared, and multivariate analysis was performed to identify factors associated with OS. Results: There was no significant difference in the estimated 5-year OS in the surgical and non-surgical groups (67% vs. 74%; p = 0.75). The presence of a solid component (SC) (hazard ratio [HR], 6.92; 95% confidence interval [CI], 3.30-14.5) and a high score of age-adjusted Charlson comorbidity index (ACCI) (≥5) (HR, 2.27; 95% CI, 1.11-4.64) were independent predictors of poor OS. In the presence of an SC, the surgical group had a significantly better OS than the non-surgical group (estimated 5-year OS, 38% vs. 18%; p = 0.031). In the absence of an SC, the prognosis of patients with a high ACCI was significantly poorer than those with a low ACCI in the surgical group (estimated 5-year OS, 59% vs. 93%; p = 0.005). Conclusions: An SC and a high ACCI are important prognostic factors in IPMN patients exhibiting HRS. Thus, patients with an SC should undergo surgical resection. However, conservative management may be the optimal treatment in patients without an SC and with a high ACCI.

Role of Charlson comorbidity index in predicting intensive care unit readmission in patients with aortic aneurysm.

The purpose of this study was to investigate the value of the Charlson comorbidity index (CCI) in predicting intensive care unit (ICU) readmission in aortic aneurysm (AA) patients. Patient information came from the Medical Information Mart for Intensive Care- IV (MIMIC-IV) database. The relationship between CCI and ICU readmission was analyzed by restricted cubic spline, generalized linear regression, trend analysis, and hierarchical analysis. The clinical value of CCI in predicting ICU readmission was analyzed by receiver operating characteristic curve, decision curve analysis, XGBoost regression, and random forest regression. A total of 523 patients with AA were enrolled in the study. Patients with AA who were readmitted to the ICU had higher width of red blood cell distribution width (RDW) and higher CCI. CCI had better performance and clinical net benefit for predicting ICU readmission than RDW. An independent nonlinear relationship was found between CCI and ICU readmission. The trend analysis suggested that the risk of ICU readmission increased with higher CCI scores. The hierarchical analysis showed that their association was mainly found in surgery requirement populations regardless of AA types. Further, CCI was found to have better clinical value in predicting ICU readmission of thoracic aortic aneurysm (TAA) patients undergoing surgery. Age, renal disease, chronic lung disease, and dementia were important components of CCI in predicting ICU readmission of TAA patients undergoing surgery. CCI was independently associated with the ICU readmission of AA patients in a positive relationship and had more favorable prediction performance in TAA patients who underwent surgery.

The value of Age-adjusted Charlson and Elixhauser-Van Walraven comorbidity index in predicting prognosis for patients undergoing heart valve surgery

ObjectiveThis study aims to compare the efficacy of the Age-adjusted Charlson Comorbidity Index (ACCI) and the Elixhauser-Van Walraven Comorbidity Index (ECI-VW) in predicting mortality risk among patients undergoing heart valve surgery.MethodsClinical data were extracted from the INSPIRE Database using R language. The Receiver Operating Characteristic (ROC) Curve was employed to assess the predictive accuracy of ACCI and ECI-VW for in-hospital all-cause mortality and post-surgical all-cause mortality at 7 and 28 days. Subgroup analysis was conducted to validate the application efficacy, and the optimal cutoff value was identified.ResultsThe study included 996 patients, with 931 survivors and 65 cases of in-hospital all-cause mortality. The area under the curve (AUC) for ACCI in predicting in-hospital all-cause mortality was 0.658 (95% CI: 0.584, 0.732), while the AUC for ECI-vw in predicting the same outcome was 0.663 (95% CI: 0.584, 0.741). For predicting all-cause mortality within 7 days post-surgery, the AUC of ACCI was 0.680 (95% CI: 0.04, 0.56), and for ECI-vw, it was 0.532 (95% CI: 0.353, 0.712). Regarding the prediction of all-cause mortality within 28 days after surgery, the AUC for ACCI was 0.724 (95% CI: 0.622, 0.827), and for ECI-vw, it was 0.653 (95% CI: 0.538, 0.69). Patients were categorized into two groups based on the ACCI cutoff value of 3.5, including Group 1 (ACCI < 3.5 points, 823 cases) and Group 2 (ACCI > 3.5 points, 173 cases). The overall survival rate for these two patient groups was calculated using the Kaplan-Meier method, revealing that the 28-day postoperative survival rate for patients in Group 1 was significantly higher than that for patients in Group 2 (P < 0.0001).ConclusionsACCI demonstrates significant predictive value for in-hospital all-cause mortality within 28 days following cardiac valve disease surgery. Patients presenting with an ACCI greater than 3.5 exhibit an increased risk of mortality within 28 days post-surgery compared to those with an ACCI less than 3.5. This finding suggests that the ACCI can serve as a preliminary tool for assessing the prognosis of patients undergoing this type of surgical intervention.

Evaluation of the Frequency of Kidney Injury in the Postoperative Critical Care Unit (PACU): A Prospective Observational Study

Background: In the study, the frequency of postoperative acute kidney injury (AKI), factors associated with AKI, and the effect of AKI on outcomes in surgical cases treated in the Postoperative intensive care unit (PACU) in the postoperative period were investigated. Materials and Method: The study is a prospective and observational study. Surgical cases treated in the PACU in the postoperative period were included in our study. Demographic characteristics of the patients, characteristics of the operation and anesthesia, Charlson Comorbidity Index (CCI) values, American Society of Anesthesiologist (ASA) risk classes, preoperative biochemistry results and preoperative hemogram results were recorded. Patients' AKI was assessed using the Risk, Injury, Failure, Loss of Function, and End-Stage Renal Disease (RIFLE) and Acute Kidney Injury Network criteria(AKIN). Results: 583 postoperative cases were examined. The frequency of AKI in PACU was 17,7%. Age, preoperative CCI, BUN, GFR values, preoperative peptic ulcer history, preoperative calcium, total bilirubin levels and the urgency of operation were the preoperative reasons for AKI. Intraoperative use of blood and colloid also affected postoperative AKI. There was a relationship between AKI and the amount of crystalloid and FFP used in PACU. In patients with AKI, the frequency of inotropic use in PACU, the frequency of the use of IMV and the duration, cardiac complication, arrhythmia, respiratory system complications, sepsis and mortality rate were higher compared to patients without AKI (p

Comparative analysis of treatment results of craniotomy and external closed drain in patients with chronic subdural hematomas

Aim. To conduct a comparative analysis of the treatment results of the patients with chronic subdural hematoma using two methods: closed external drainage and craniotomy.Materials and methods. The data of 55 patients with chronic subdural hematoma operated in the I.I. Dzhanelidze St. Petersburg Research Institute of Emergency Medicine from 2019 to mid-2023 was analyses retrospectively. Depending on the treatment method, patients were divided into 2 groups: external subdural drains (n = 30, 55.5 %) and evacuation of hematoma via craniotomy (n = 25, 45.5 %). The patients in the groups were comparable in clinical features, radiological characteristics and the Charlson comorbidity index. In the postoperative period, the following were assessed: hematoma thickness and displacement of median structures, occurrence of surgical complications, and mortality.Results. There were no differences between the groupsin the midline shift, the frequency of postoperative complications, reoperation and deaths. The thickness of the hematomas according to the control computed tomography scans of the brain was lower in the craniotomy group, but this did not determine the outcome of treatment. Patients with a Charlson Comorbidity Index value of 4 points or higher were significantly more likely to have an unfavorable outcome. The sensitivity and specificity of the index in predicting an unfavorable outcome was 71.4 and 69.7 %, respectively.Conclusion. There were no differencesin the effectiveness of craniotomy and externalsubdural drains of chronic subdural hematoma. In this regard, it is necessary to give preference to minimally invasive methods of treatment. Assessment of the comorbid status allows predicting an unfavorable outcome of treatment.

Prognostic Value of Lymph Node Ratio (LNR) in Patients with Postoperative N2 Feature in Non-Small Cell Lung Cancer (NSCLC).

Introduction: One of the most important prognostic factors in non-small cell lung cancer (NSCLC), a condition with a high mortality rate, is the presence of mediastinal lymph node metastases alongside distant metastases. The aim of this study was to evaluate the prognostic value of selected parameters of N2 stage NSCLC with a special focus on lymph node ratio (LNR). Material: The study included 163 patients (61 women and 102 men) operated on due to NSCLC, postoperatively diagnosed as stage N2. The age of the patients ranged from 38 to 82 years (mean age: 62.4 years). The effects of the following factors on clinical data and survival rate were assessed: N1 stage, total number of all metastatic nodes, LNR and LNR N2 ratios, and the presence of skip, single- or multistation metastases. Results: Univariate analysis showed patient survival to be correlated with LNR and LNR N2 ratios, single/multistation metastases, and the number of nodes involved in metastasis. A multivariate model based on patient clinical data found nicotine dependence (p = 0.013), LNR > 0.26 (p = 0.004), and Charlson Comorbidity Index (CCI) value > 3 (p = 0.014) to be independent adverse prognostic factors in this group. Conclusions: LNR ratio is a significant cancer disease-derived independent prognostic factor for patients with postoperative N2 stage NSCLC. In addition, smoking and comorbidities also appear to have prognostic value.

Gentamicin combination treatment is associated with lower mortality in patients with invasive listeriosis: a retrospective analysis.

Listeria monocytogenes causes severe bacterial infections with the highest mortality rate among foodborne pathogens in Europe. Combination treatment with ampicillin and gentamicin is recommended for invasive manifestations. However, evidence to support this treatment approach remains limited due to a lack of randomised controlled trials. To explore this critical issue further, we conducted this retrospective, single-center study. We identified all patients hospitalized with invasive listeriosis at the University Medical Center Hamburg-Eppendorf between 2009 and 2020 and analyzed the effect of gentamicin combination treatment versus monotherapy on 90-day mortality. In total, 36 patients with invasive listeriosis were included, of which 21 patients received gentamicin combination treatment and 15 received monotherapy. The mean age-adjusted Charlson Comorbidity Index (aaCCI) value was lower in the gentamicin combination treatment group (5.4 vs. 7.4). Neurolisteriosis was more common in the gentamicin group (81% vs. 20%). The 90-day mortality was with significantly lower in the gentamicin combination treatment group (10%) compared to the monotherapy group (60%). Multivariable cox regression analysis, adjusted for a propensity score computed based on neurolisteriosis, aaCCI and sex, revealed a significantly reduced hazard ratio of 0.07 (95% CI: 0.01-0.53, p = 0.01) for 90-day mortality for the gentamicin combination treatment. This retrospective study highlights the benefit of gentamicin combination treatment in reducing the 90-day mortality rate among patients with invasive listeriosis. The high prevalence of monotherapy in this study cohort raises concerns about the adequacy of antibiotic therapy in clinical practice.

Estimating risk for pancreatic cancer among 9.4 million veterans in care.

10544 Background: Screening for pancreatic ductal adenocarcinoma (PDAC) has focused on individuals with a hereditary component, accounting for only 10% of PDAC events. Using the electronic health record, we developed a PDAC risk prediction model in a general population in the Veterans Health Administration (VA), the largest integrated health system in the US. Methods: We included all individuals from 2002- 2021 with ≥1 inpatient or outpatient VA encounter and recorded race, starting follow-up 1.5 years after first VA encounter. We excluded those who developed PDAC before start of follow-up. We used the multivariable Cox proportional hazards model in the derivation dataset (random 70% of cohort) to estimate the coefficients associated with each predictor for our outcome, time to PDAC (3 and 10 years), censoring at loss to follow-up or 12/31/2021. Candidate predictors included age, gender, race/ethnicity, sex, BMI, smoking status, alcohol use (alcohol use/related disorders and AUDIT-C), diabetes, pancreatitis, Hepatitis C, HIV, liver disease, cholecystectomy, pancreatic cysts, Charlson comorbidity index and common laboratory values. Selection of predictors was based on clinical reasoning, extent of missing values and model fit (Akaike Information Criterion and Harrell’s c–statistic). We evaluated model discrimination using c – statistic and model calibration comparing observed Kaplan – Meier estimated incidence vs. predicted risk score. Results: Among 9.4 million individuals, we observed 19,839 cases of PDAC within 10 years (6,022 cases within 3 years). Median baseline age was 58.5 years, 75.0% were White, and 16.3% were Black. Final predictors included age, gender, smoking, alcohol use (alcohol use/related disorders and AUDIT-C), BMI, diabetes, pancreatitis, pancreatic cyst, and history of cancer (Table, c-statistic in the derivation cohort 3 years: 0.79; 10 years: 0.77). Ten-year risk ranged maximally from 0-5.5%. Preliminary studies suggest labs do not clinically improve model performance. Conclusions: We developed a novel prediction model using available clinical data in a general population that identifies PDAC with high accuracy. Future work will try to identify additional predictors to improve the range of risk predicted. We will validate our findings in the testing set and in external cohorts. [Table: see text]

Prognostic value and association of the age-adjusted Charlson Comorbidity Index with sarcopenia within patients with gastric cancer after radical resection

PurposeThe association between the age-adjusted Charlson Comorbidity Index (ACCI) and sarcopenia in patients with gastric cancer (GC) remains ambiguous. This study aimed to investigate the association between the ACCI and sarcopenia and the prognostic value in patients with GC after radical resection. In addition, this study aimed to develop a novel prognostic scoring system based on these factors. MethodsUnivariate and multivariate Cox regression analyses were used to determine prognostic factors in patients undergoing radical GC resection. Based on the ACCI and sarcopenia, a new prognostic score (age-adjusted Charlson Comorbidity Index and Sarcopenia [ACCIS]) was established, and its prognostic value was assessed. ResultsThis study included 1068 patients with GC. Multivariate analysis revealed that the ACCI and sarcopenia were independent risk factors during the prognosis of GC (P = 0.001 and P < 0.001, respectively). A higher ACCI score independently predicted sarcopenia (P = 0.014). A high ACCIS score was associated with a greater American Society of Anesthesiologists score, higher pathologic TNM (pTNM) stage, and larger tumor size (all P < 0.05). Multivariate analysis demonstrated that the ACCIS independently predicted the prognosis for patients with GC (P < 0.001). By incorporating the ACCIS score into a prognostic model with sex, pTNM stage, tumor size, and tumor differentiation, we constructed a nomogram to predict the prognosis accurately (concordance index of 0.741). ConclusionThe ACCI score and sarcopenia are significantly correlated in patients with GC. The integration of the ACCI score and sarcopenia markedly enhances the accuracy of prognostic predictions in patients with GC.

Can The Systemic Immune-Inflammation Index (SII) and Charlson Comorbidity Index (CCI) be used to predict mortality in patients with necrotizing fasciitis?

This study aimed to determine the impact of mortality and morbidity indices on the diagnosis and prognosis of patients suffering from necrotizing fasciitis. A retrospective analysis was performed on 41 patients (26 females, 15 males) with necrotizing fasciitis (NF). The SII (Systemic Immune-Inflammation Index) was computed using the formula SII = (P × N)/L, where P, N, and L measure the counts of peripheral platelets, neutrophils, and lymphocytes, respectively. This study evaluated the clinicopathological characteristics and follow-up information to assess the comparative effectiveness of SII, CCI (Charlson Comorbidity Index), and LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) scores as mortality and morbidity indices for patients with NF. The optimal cut-off for SII was determined to be 455. The SII value in the group with mortality was significantly higher compared to the group without mortality (p < 0.05). The CCI value in the group with mortality was significantly higher than the group without mortality (p < 0.05). The SII and CCI values were found to be effective in distinguishing between patients who suffered mortality and those who did not. SII is a powerful tool for predicting mortality in patients with necrotizing fasciitis (NF). The SII index provides a novel, easily accessible, and inexpensive indicator for monitoring the progress and predicting the survival of patients with NF.

The role of lactate-to-albumin ratio to predict 30-day risk of death in patients with sepsis in the emergency department: a decision tree analysis

Background Accurately estimating the prognosis of septic patients on arrival in the emergency department (ED) is clinically challenging. The lactate-to-albumin ratio (LAR) has recently been proposed to improve the predictive performance of septic patients admitted to the ICU. Objectives This study aims to assess whether the LAR could be used as an early prognostic marker of 30-day mortality in patients with sepsis in the ED. Methods A prospective observational study was conducted in the ED of the Hospital of Merano. All patients with a diagnosis of sepsis were considered. The LAR was recorded on arrival in the ED. The primary outcome measure was mortality at 30 days. The predictive role of the LAR for mortality was evaluated with the area under the ROC curve, logistic regression adjusted for the Charlson Comorbidity Index value, National Early Warning Score, and Sequential Organ Failure score, and with decision tree analysis. Results 459 patients were enrolled, of whom 17% (78/459) died at 30 days. The median LAR of the patients who died at 30 days (0.78 [0.45–1.19]) was significantly higher than the median LAR of survivors (0.42 [0.27–0.65]) (p < 0.001). The discriminatory ability of the LAR for death at 30 days was 0.738, higher than that of lactate alone (0.692), and slightly lower than that of albumin alone (0.753). The decision trees confirmed the role of the LAR as an independent risk factor for mortality. Conclusion The LAR can be used as an index to better predict the 30-day risk of death in septic patients.

Iron-Related Laboratory Profile May Predict Response and MRD Negativity Rate in Acute Myeloid Leukemia Patients

Introduction: iron metabolism is deeply related to the pathogenesis and prognosis of acute myeloid leukemia (AML) and remains largely unexplored in the era of MRD-driven therapy. Several studies have assessed prognostic implications of altered iron-related laboratory values at diagnosis and there is growing interest towards the inherent pathobiology of iron in AML since new therapeutic strategies (i.e. targeting ferroptosis) are being investigated. Nonetheless, no clear association has been established between a specific risk subtype of AML within the new ELN2022 classification and a metabolic iron signature at diagnosis. Furthermore, data correlating an altered iron profile at diagnosis with post-induction response, rate of infections and need for PRBC transfusions are lacking. Methods: We performed a retrospective monocentric analysis in intensively (IC) and non-intensively (NIC) treated AML patients. Effects of altered iron parameters at diagnosis (at least one between ferritin and transferrin saturation [TSAT] according to local-lab reference range) were investigated sub-dividing patients into an altered (AC) vs a non-altered cohort (NAC). 110 AML patients diagnosed between June 2019 and April 2023 were screened for this study. 62 patients were eligible: 46 IC (AC:22 vs NAC:24) and 16 NIC (AC:12 vs NAC:4) patients were analysed. 48 patients were excluded because of previous PRBC transfusions (if &amp;gt; 5 PRBC), active infection at diagnosis or severe comorbidity. We compared the two cohorts in terms of ELN22 risk classification, frequency of MDS-related mutations using an NGS-based panel, TP53 mutation rate, and rate of complex karyotype (CK). Furthermore, we compared AC vs NAC (both in IC and NIC) in terms of overall survival (OS), morphologic complete response (CR) rate, rate of post-induction measurable residual disease negativity (both PCR-based and MFC based), rate of G4 infections and PRBC transfusions during induction. In addition, ferritin and TSAT cut-off values to predict CR and MRD response were calculated using ROC analysis. Selection bias was assessed considering age, risk category, PRBC count before therapy, therapy regimen, comorbidity using Charlson comorbidity index (CCI) and CRP values. Results: There was not a significant difference in terms of high risk subtype frequency between AC vs NAC group in both the IC and NIC population (IC p: 0,39/NIC p: 0,29). In both macro-groups, the AC group did not show a significantly higher frequency of CK (IC p: 0,66/NIC p: 0,84), TP53 mutations (IC p: 0,91/NIC p: 1) and MDS-related mutations (IC p: 0,76/NIC p: 0,14). OS was not significantly different in the AC group in both IC and NIC (IC p: 0,16/ NIC p: 0,62). No significant differences were found between the two cohorts in terms of post-induction CR rate (IC p: 0,6/NIC p: 0,25), MRD-negativity rate (IC p: 1/NIC p: 1) and rate of G4 infective complications (IC p: 0,5/NIC p: 0,59). In the IC patients with high risk disease, an altered iron profile at diagnosis correlated with a higher need (&amp;gt;10) of PRBC during induction compared to high risk patients with normal iron profile (p-value 0,014). Iron-related lab values at diagnosis were informative in predicting post-induction CR and MRD status in both the IC and NIC population. In the IC population (figure 1) a ferritin cut-off value of 190 ng/ml (AUC: 0.625) predicted CR rate while a TSAT cut-off value of 48% (AUC: 0,587) was informative about MRD negativity rate. Similarly, in the NIC population a ferritin cut-off value of 246 ng/ml (AUC: 0,772) was informative about MRD negativity rate (figure 2). Conclusions: Our retrospective study did not find an undisputable correlation between a specific ELN2022 AML risk subtype or gene-mutation using NGS and altered iron lab-values at diagnosis, whereas an association in ELN2022 high risk IC patients regarding PRBC transfused during induction in AC vs NAC was found. Although the AC did not exhibit a shorter OS compared to the NAC in both IC and NIC population, specific iron-related cut-off values were informative about disease response to both intensive and non-intensive treatments, including MRD negativity rate. Larger clinical trials to dissect iron-metabolism in AML pathogenesis, diagnosis and treatment are highly warranted. Keywords: Acute Myeloid Leukemia, iron metabolism, ferritin, transferrin saturation, ELN22, MDS-related gene mutations, NGS, induction therapy, MRD, OS, transfusion rate

Medication error and associated factors among adults admitted to emergency ward at the university of Gondar comprehensive specialized hospital, North-West Ethiopia: a cross-sectional study, 2022

BackgroundMedication errors are the most common cause of preventable adverse drug events at the emergency ward.ObjectivesThis study assessed medication errors and associated factors among adult patients admitted to the emergency ward at the University of Gondar Comprehensive Specialized Hospital, North-West Ethiopia.MethodsA cross-sectional study was conducted from June 1, 2022, to August 30, 2022. Data were entered into EpiData Manager 4.6.0.0 for clearing and exported to SPSS version 24 for analysis. Descriptive statistics such as frequencies, medians with an interquartile range and inferential statistics like binary logistic regression were used for data analysis. The level of significance was declared at a p value less than 0.05 with a 95% confidence interval.ResultsFrom 422 study participants, medication errors were found in three-fourths (74.4%) of study participants. The most frequent type of medication error was omitted dose (26.27%). From a total of 491 medication errors, 97.75% were not prevented before reaching patients. More than one-third (38.9%) of medication errors had potentially moderate harmful outcomes. More than half (55.15%) of possible causes of medication errors committed by staff are due to behavioral factors. Physicians accepted 99.16% and nurses accepted 98.71% of clinical pharmacist intervention. Hospital stay ≥ 6 days (AOR: 3.00 95% CI 1.65–5.45, p < 0.001), polypharmacy (AOR: 5.47, 95% CI 2.77–10.81 p < 0.001), and Charlson comorbidity index ≥ 3 (AOR: 1.94, 95% CI (1.02–3.68), p < 0.04) significantly associated with medication error.ConclusionsAbout three-fourths of adult patients admitted to the emergency ward experienced medication errors. A considerable amount of medication errors were potentially moderately harmful. Most medication errors were due to behavioral factors. Most clinical pharmacists’ interventions were accepted by physicians and nurses. Patients who stayed longer at the emergency ward, had a Charlson comorbidity index value of ≥ 3, and were on polypharmacy were at high risk of medication error. The hospital should strive to reduce medication errors at the emergency ward.

The impact of severe depression on the survival of older patients with end-stage kidney disease.

Incidence of depression increases in patients with end-stage kidney disease (ESKD). We evaluated the association between depression and mortality among older patients with ESKD, which has not been studied previously. This nationwide prospective cohort study included 487 patients with ESKD aged >65 years, who were categorized into minimal, mild-to-moderate, and severe depression groups based on their Beck Depression Inventory-II (BDI-II) scores. Predisposing factors for high BDI-II scores and the association between the scores and survival were analyzed. The severe depression group showed a higher modified Charlson comorbidity index value and lower serum albumin, phosphate, and uric acid levels than the other depression groups. The Kaplan-Meier curve revealed a significantly lower survival in the severe depression group than in the minimal and mild-to-moderate depression groups (p = 0.011). Multivariate Cox regression analysis confirmed that severe depression was an independent risk factor for mortality in the study cohort (hazard ratio, 1.39; 95% confidence interval, 1.01-1.91; p = 0.041). Additionally, BDI-II scores were associated with modified Charlson comorbidity index (p = 0.009) and serum albumin level (p = 0.004) in multivariate linear regression. Among the three depressive symptoms, higher somatic symptom scores were associated with increased mortality. Severe depression among older patients with ESKD increases mortality compared with minimal or mild-to-moderate depression, and patients with concomitant somatic symptoms require careful management of their comorbidities and nutritional status.

The Prognostic Value of the Age-Adjusted Charlson Comorbidity Index Among the Elderly with Breast Cancer.

This study aimed to assess the effect of comorbidities on prognosis using the Age-adjusted Charlson Comorbidity Index (ACCI) among the elderly with breast cancer (BC). This study included 745 patients divided into two groups following the ACCI score (≤3 vs >3). Multivariate logistic regression analysis was conducted for all kinds of outcomes, including BC-specific death (BCSD) and non-breast cancer-specific death (NBCSD). The Kaplan-Meier curves were plotted, and survival analysis was conducted for disease-free survival (DFS), overall survival (OS), BC-specific survival (BCSS), and non-BCSS (NBCSS). A significantly higher NBCSD was found in the high-score (ACCI > 3) group than in the low-score (ACCI < 3) group (p = 0.032). The multivariate logistic regression analysis revealed ACCI score as an independent affecting factor for all-cause death (hazard ratio [HR] = 0.42, 95% confidence interval [CI]: 0.22-0.83, p = 0.012) and NBCSD (HR = 0.41, 95% CI: 0.20-0.87, p = 0.020). The Kaplan-Meier curves revealed statistical differences only in NBCSS between the two groups (p = 0.039). Subgroup analysis revealed a worse prognosis in the high-score group for OS and NBCSS among hormone receptor-positive participants and those who without undergoing axillary dissection or receiving chemotherapy (all p < 0.05). Multivariate Cox regression analysis revealed ACCI as an independent prognostic predictor for OS (HR = 2.18, 95% CI: 1.22-3.92, p = 0.009) and NBCSS (HR = 2.04, 95% CI: 1.02-4.08, p = 0.044). ACCI was indeed an effective indicator of the effects of comorbidities on survival among elderly patients with BC. However, the co-effect from age and comorbidities was not significant enough on cancer-specific prognosis, although it exerted a significant effect on treatments received.

#5293 THE IMPACT OF SEVERE DEPRESSION ON THE SURVIVAL OF OLDER PATIENTS WITH END-STAGE KIDNEY DISEASE

Abstract Background and Aims Incidence of depression increases in patients with end-stage kidney disease (ESKD). We evaluated the association between depression and mortality among older patients with ESKD, which has not been studied previously. Method This nationwide prospective cohort study included 487 patients with ESKD aged &amp;gt; 65 years, who were categorized into minimal, mild-to-moderate, and severe depression groups based on their Beck Depression Inventory-II (BDI-II) scores. BDI-II scores were separated into three symptom domains: affective, cognitive, and somatic depressive symptoms. The association between the depression groups and survival were analyzed using multivariate Cox proportional hazard regression models. Predisposing factors for high BDI-II scores were evaluated using logistic regression analysis. The associations among the three depressive-symptom domains and survival were also analyzed. Results The severe depression group showed a higher modified Charlson comorbidity index value and lower serum albumin, phosphate, and uric acid levels than the other depression groups. The Kaplan–Meier curve revealed a significantly lower survival in the severe depression group than in the minimal and mild-to-moderate depression groups (P = 0.011). Multivariate Cox regression analysis confirmed that severe depression was an independent risk factor for mortality in the study cohort [hazard ratio (HR), 1.39; 95% confidence interval (CI), 1.01–1.91; P = 0.041). BDI-II scores were associated with modified Charlson comorbidity index (P = 0.009) and serum albumin level (P = 0.004) in multivariate linear regression. Among the three depressive symptoms, higher somatic symptom scores were associated with increased mortality (HR, 2.45; 95% CI, 1.25–4.79; P = 0.009). Conclusion Among older patients with ESKD, severe depression increases mortality compared with minimal or mild-to-moderate depression. And patients with concomitant somatic symptoms require careful management of their comorbidities and nutritional status.