Deterioration In Patients Research Articles

Multisite Pragmatic Cluster-Randomized Controlled Trial of the CONCERN Early Warning System.

Late predictions of hospitalized patient deterioration, resulting from early warning systems (EWS) with limited data sources and/or a care team's lack of shared situational awareness, contribute to delays in clinical interventions. The COmmunicating Narrative Concerns Entered by RNs (CONCERN) Early Warning System (EWS) uses real-time nursing surveillance documentation patterns in its machine learning algorithm to identify patients' deterioration risk up to 42 hours earlier than other EWSs. To test our a priori hypothesis that patients with care teams informed by the CONCERN EWS intervention have a lower mortality rate and shorter length of stay (LOS) than the patients with teams not informed by CONCERN EWS. One-year multisite, pragmatic controlled clinical trial with cluster-randomization of acute and intensive care units to intervention or usual-care groups. Two large U.S. health systems. Adult patients admitted to acute and intensive care units, excluding those on hospice/palliative/comfort care, or with Do Not Resuscitate/Do Not Intubate orders. The CONCERN EWS intervention calculates patient deterioration risk based on nurses' concern levels measured by surveillance documentation patterns, and it displays the categorical risk score (low, increased, high) in the electronic health record (EHR) for care team members. Primary outcomes: in-hospital mortality, LOS; survival analysis was used. Secondary outcomes: cardiopulmonary arrest, sepsis, unanticipated ICU transfers, 30-day hospital readmission. A total of 60 893 hospital encounters (33 024 intervention and 27 869 usual-care) were included. Both groups had similar patient age, race, ethnicity, and illness severity distributions. Patients in the intervention group had a 35.6% decreased risk of death (adjusted hazard ratio [HR], 0.644; 95% confidence interval [CI], 0.532-0.778; P<.0001), 11.2% decreased LOS (adjusted incidence rate ratio, 0.914; 95% CI, 0.902-0.926; P<.0001), 7.5% decreased risk of sepsis (adjusted HR, 0.925; 95% CI, 0.861-0.993; P=.0317), and 24.9% increased risk of unanticipated ICU transfer (adjusted HR, 1.249; 95% CI, 1.093-1.426; P=.0011) compared with patients in the usual-care group. A hospital-wide EWS based on nursing surveillance patterns decreased in-hospital mortality, sepsis, and LOS when integrated into the care team's EHR workflow. ClinicalTrials.gov Identifier: NCT03911687.

Beyond Unplanned ICU Transfers: Linking a Revised Definition of Deterioration to Patient Outcomes.

To develop an electronic descriptor of clinical deterioration for hospitalized patients that predicts short-term mortality and identifies patient deterioration earlier than current standard definitions. A retrospective study using exploratory record review, quantitative analysis, and regression analyses. Twelve-hospital community-academic health system. All adult patients with an acute hospital encounter between January 1, 2018, and December 31, 2022. Not applicable. Clinical trigger events were selected and used to create a revised electronic definition of deterioration, encompassing signals of respiratory failure, bleeding, and hypotension occurring in proximity to ICU transfer. Patients meeting the revised definition were 12.5 times more likely to die within 7 days (adjusted odds ratio 12.5; 95% CI, 8.9-17.4) and had a 95.3% longer length of stay (95% CI, 88.6-102.3%) compared with those who were transferred to the ICU or died regardless of meeting the revised definition. Among the 1812 patients who met the revised definition of deterioration before ICU transfer (52.4%), the median detection time was 157.0 min earlier (interquartile range 64.0-363.5 min). The revised definition of deterioration establishes an electronic descriptor of clinical deterioration that is strongly associated with short-term mortality and length of stay and identifies deterioration over 2.5 hours earlier than ICU transfer. Incorporating the revised definition of deterioration into the training and validation of early warning system algorithms may enhance their timeliness and clinical accuracy.

Fine-grained Patient Similarity Measuring using Contrastive Graph Similarity Networks.

Predictive analytics using Electronic Health Records (EHRs) have become an active research area in recent years, especially with the development of deep learning techniques. A popular EHR data analysis paradigm in deep learning is patient representation learning, which aims to learn a condensed mathematical representation of individual patients. However, EHR data are often inherently irregular, i.e., data entries were captured at different times as well as with different contents due to the individualized needs of each patient. Most of the work focused on the provision of deep neural networks with attention mechanisms that generate complete patient representations that can be readily used for downstream prediction tasks. However, such approaches fail to take patient similarity into account, which is generally used in clinical reasoning scenarios. This study presents a new Contrastive Graph Similarity Network for similarity calculation among patients in large EHR datasets. Particularly, we apply graph-based similarity analysis that explicitly extracts the clinical characteristics of each patient and aggregates the information of similar patients to generate rich patient representations. Experimental results on real-world EHR databases demonstrate the effectiveness and superiority of our method for the task of vital signs imputation and ICU patient deterioration prediction.

More competent informal caregivers reduce advanced cancer patients' unplanned healthcare use and costs.

Patients with metastatic cancer experience high healthcare use and costs, most of which are unplanned. We aimed to assess whether patients with more competent informal caregivers have lower unplanned healthcare use and costs. This study used data from a prospective cohort of patients with solid metastatic cancer. Patients and their informal family caregivers were surveyed every 3 months until patients' death. Patients' unplanned healthcare use/costs were examined through hospital records. Caregivers responded to the 4-item Caregiver Competence Scale. First, in a deceased subsample of patients and their caregivers, we used patients' last 2 years of data (226 dyads) to assess the association between caregivers' competency (independent variable) and patients' unplanned healthcare use/costs (outcomes). Next, in a prospective sample of patient-caregiver dyads (up to 15 surveys), we assessed whether patients' functional well-being and psychological distress moderated the association between caregivers' competency and unplanned healthcare use/costs (311 dyads). In the deceased subsample, during last 2 years of patients' life, caregivers' higher competency lowered the odds of patients' unplanned healthcare use [OR (CI) = 0.86 (0.75, 0.98), p = 0.03], and was associated with a significant reduction in unplanned healthcare costs [Coeff (CI) = -0.19 (-0.36, -0.01), p = 0.03]. In the prospective sample, patients' functional well-being and psychological distress moderated the association between caregivers' competency and patients' unplanned healthcare use/costs. With deterioration in patients' condition and an increase in caregiving demands, improving caregivers' competency can reduce patients' unplanned healthcare use and costs. This should be further tested in future trials.

The Use of TNF-α Inhibitors in Active Ankylosing Spondylitis Treatment.

Ankylosing spondylitis (AS) is a challenging disease, characterized by chronic inflammation and structural damage primarily affecting the axial skeleton, while extra-articular manifestations may also appear. This results in the deterioration of patients' quality of life. Over the past few decades, tumor necrosis factor-α (TNF-α) inhibitors have revolutionized the management of AS, offering substantial relief from symptoms and improving patient outcomes. The aim of this review is to assess the efficacy of TNF-α inhibitors in patients with active AS. A search was performed in the PubMed database using the following keywords: ("TNF alpha inhibitors" OR "anti TNF-a" OR "TNF-a inhibitors" OR "anti TNF-alpha" OR "Etanercept " OR "Golimumab" OR "Infliximab" OR "Certolizumab pegol" OR "Adalimumab") AND "ankylosing spondylitis". The search was completed in February 2024, and 35 studies were included in this review following PRISMA guidelines. The findings reveal evidence supporting the efficacy of TNF-α inhibitors in reducing inflammation, preventing structural damage, and enhancing overall well-being in AS patients. Overall, TNF-α inhibitors have emerged as a cornerstone in the therapeutic algorithm against AS with a very satisfactory safety profile.

Circulating bacterial peptides and linked metabolomic signatures are indicative of early mortality in pediatric cirrhosis.

Patients with pediatric cirrhosis-sepsis (PC-S) attain early mortality. Plasma bacterial composition, the cognate metabolites, and their contribution to the deterioration of patients with PC-S to early mortality are unknown. We aimed to delineate the plasma metaproteome-metabolome landscape and identify molecular indicators capable of segregating patients with PC-S predisposed to early mortality in plasma, and we further validated the selected metabolite panel in paired 1-drop blood samples using untargeted metaproteomics-metabolomics by UHPLC-HRMS followed by validation using machine-learning algorithms. We enrolled 160 patients with liver diseases (cirrhosis-sepsis/nonsepsis [n=110] and noncirrhosis [n=50]) and performed untargeted metaproteomics-metabolomics on a training cohort of 110 patients (Cirrhosis-Sepsis/Nonsepsis, n=70 and noncirrhosis, n=40). The candidate predictors were validated on 2 test cohorts-T1 (plasma test cohort) and T2 (1-drop blood test cohort). Both T1 and T2 had 120 patients each, of which 70 were from the training cohort. Increased levels of tryptophan metabolites and Salmonella enterica and Escherichia coli-associated peptides segregated patients with cirrhosis. Increased levels of deoxyribose-1-phosphate, N5-citryl-d-ornithine, and Herbinix hemicellulolytic and Leifsonia xyli segregated patients with PC-S. MMCN-based integration analysis of WMCNA-WMpCNA identified key microbial-metabolic modules linked to PC-S nonsurvivors. Increased Indican, Staphylobillin, glucose-6-phosphate, 2-octenoylcarnitine, palmitic acid, and guanidoacetic acid along with L. xyli, Mycoplasma genitalium, and Hungateiclostridium thermocellum segregated PC-S nonsurvivors and superseded the liver disease severity indices with high accuracy, sensitivity, and specificity for mortality prediction using random forest machine-learning algorithm. Our study reveals a novel metabolite signature panel capable of segregating patients with PC-S predisposed to early mortality using as low as 1-drop blood.

The survival benefits and the risk of severe renal injury of immune checkpoint inhibitors in patients with cancer: The real-world evidence from the National Clinical Cohort Collaborative (N3C).

e24142 Background: The survival benefits and the risks of severe immune-related adverse events (sirAEs) of Immune checkpoint inhibitors (ICI) vary dramatically among cancer patients. Among sirAEs, acute kidney injury (AKI) incidences are rising, often cause sustained renal damage, and are responsible for the deterioration of patients’ overall health and quality of life. There is an urgent need to support oncologists and nephrologists in choosing the right ICI drugs for the right patients. We aim to comprehensively scrutinize the tradeoff between the survival benefits and the severe AKI risk for ICI patients by leveraging the national electronic medical records (EMR) from the National Clinical Cohort Collaborative (N3C) registry. Our work provides real-world evidence for clinical decisions on ICI use. Methods: Cancer patients treated with ICI are followed up for at least 6 months using N3C data (01/01/2018 - 01/19/2024). Primary outcomes included severe AKI within 6 months of initiation or mortality up to the last follow-up. We fit multivariable Cox proportional hazards models to evaluate the effect of various ICI types, adjusting for age, gender, race, cancer types, smoking status, and comorbidities. Results: Our study cohort included 55,767 patients who received an ICI, with 25,197 deaths and 6,458 severe AKI events. The most common ICI used were PD-1 inhibitors (74.3%), PD-L1 inhibitors (16.6%), CTLA-4 inhibitors (0.3%), and combination treatments of PD-1 and CTLA-4 inhibitors (8.8%). Observed long-term severe AKI incidences exceeded prior reports, with 96%, 92%, 88%, and 71% at 1, 3, 6, and 36 months. Survival benefits of PD-1, CTLA-4 and their combinations versus PD-L1 inhibitors were comparable (HR: 0.94 [95%CI: 0.91–0.97]; HR: 0.81 [95%CI: 0.63–1.02]; HR: 1.09 [95%CI: 1.04–1.15]). Severe AKI risks were higher with CTLA-4 and combination therapy (HR: 1.48 [95%CI: 0.96–2.28]; HR: 1.96 [95%CI: 1.78–2.16]) compared to PD-L1 inhibitors, with PD-1 inhibitors also showing increased risk (HR: 1.15 [95%CI: 1.07–1.23]). We also scrutinize risk factors associated with significant AKI risk, including a history of AKI, congestive heart failure, dementia, complicated diabetes, hypertension, liver disease, other immunocompromised diseases, and cancers of the gynecologic type, prostate cancer, and gastrointestinal cancers, and being of Black race. Conclusions: Our work provides up-to-date and comprehensive real-world evidence of the survival benefits and severe renal injury risks for clinical decisions of ICI therapy. PD-L1 inhibitors are associated with a lower risk of severe AKI compared to PD-1, CTLA-4 inhibitors, and their combination. Future research should focus on identifying patient subgroups that may benefit from specific ICI therapies while minimizing adverse outcomes.

Interleukin-6 and Biomarkers Predict Outcomes in People with Diabetes and COVID-19 Infection

Abstract Objective: The study aimed to evaluate the association between interleukin-(IL-6) and other inflammatory markers (ferritin, D-dimer, and C-reactive protein [CRP]) in severe and critical coronavirus disease 2019 (COVID-19) infection severing from diabetic mellitus (DM). Materials and Methods: A total of 130 patients confirmed with COVID-19 infection in a Laboratory of the Ministry of Health/Department of Public Health and Al-Amal Specialized Hospital for Communicable Diseases from January 1, 2022, to May 1, 2022, were included in the study. Demographic and clinical data, signs and symptoms, diabetics history, laboratory diagnosis (reverse-transcription polymerase chain reaction), as well chest computed tomography were collected and analyzed. The patients were divided according to the severity of the disease into three groups: mild cases (39%), severe cases (33%), and critical cases (28%). Results: The results revealed that 70 of the 130 severe acute respiratory syndrome coronavirus-2 infected patients had diabetes and were at a high risk of a severe and critical outcome. Furthermore, the level of proinflammatory biomarkers, such as IL-6 and other inflammatory biomarkers, such as CRP, serum ferritin, and D-dimer, were significantly higher (P &lt; 0.01) in patients with diabetes compared with those without diabetes and the control group. Conclusion: This study concludes that according to COVID-19, DM must be a consideration of high-risk factor for the rapid progression of COVID-19 and an increased mortality rate. A recent study suggests that COVID-19 patients with diabetes are more susceptible to cytokine storms, eventually leading to rapid deterioration of patients’ health.

Wave Separation Analysis to Assess Cardiovascular Alterations Induced by Sepsis.

Sepsis induces a severe decompensation of arterial and cardiac functional properties, leading to important modifications of arterial blood pressure (ABP) waveform, not resolved by recommended therapy, as shown by previous works. The aim of this study is to quantify the changes in ABP waveform morphology and wave reflections during a long-term swine experiment of polymicrobial sepsis and resuscitation, to deepen the understanding of the cardiovascular response to standard resuscitation therapy. We analyzed 14 pigs: polymicrobial sepsis was induced in 9 pigs followed by standard resuscitation and 5 pigs were treated as sham controls. Septic animals were studied at baseline (T1), after sepsis development (T2), and after 24 h (T3) and 48 h (T4) of therapy administration, and sham controls at the same time points. ABP and arterial blood flow were measured in the left and right carotid artery, respectively. Pulse wave analysis and wave separation techniques were used to estimate arterial input impedance, carotid characteristic impedance, forward and backward waves, indices of wave reflections such as reflection magnitude and reflection index, and augmentation index. Sepsis led to an acute alteration of ABP waveform passing from type A to type B or C; consistently, the reflection phenomena were significantly reduced. The resuscitation was successful in reaching targeted hemodynamic stability, but it failed in restoring a physiological blood propagation and reflection. Septic pigs persistently showed altered reflected waves even after 48 hours of successful therapy according to guidelines, suggesting a persistent hidden cardiovascular disorder. The proposed indices may be useful to unravel the complex cardiovascular response to therapy administration in septic patients and could potentially be used for risk stratification of patient deterioration. Whether alterations of blood propagation and reflection contribute to persisting organ dysfunction after hemodynamic stabilization should be further investigated.

Adding Genetics to the Risk Factors Model Improved Accuracy for Detecting Visual Field Progression in Newly Diagnosed Exfoliation Glaucoma Patients.

This study aims to determine whether including genetics as a risk factor for progression will improve the accuracy of the models used in newly diagnosed exfoliation glaucoma patients. This was a prospective cohort study. This study included only patients who were newly diagnosed with exfoliation glaucoma and received treatment upon inclusion. Blood samples were taken from all patients at inclusion to test for the single nucleotide polymorphisms (SNPs) LOXL-1 rs2165241 and rs1048661. This study found that the frequency of SNPs, as well as intraocular pressure (IOP), mean deviation (MD), and visual field index (VFI) values at diagnosis, were significant predictors of visual field deterioration (p ≤ 0.001). This study showed that interaction terms, including SNPs, were highly significant (p ≤ 0.001). Furthermore, logistic regression analysis also showed highly significant results for interaction terms when SNPs were included (p ≤ 0.001). Finally, the area under the curve (AUC) analysis showed an increased value of around 10-20% when SNPs were included. Adding genetic factors to the well-known clinical risk factors can increase the accuracy of models for predicting visual field deterioration in exfoliation glaucoma patients. However, further studies are needed to investigate the role of other genes in this process.

Listen to me, I really am sick! Patient and family narratives of clinical deterioration before and during rapid response system intervention.

To explore patient and family narratives about their recognition and response to clinical deterioration and their interactions with clinicians prior to and during Medical Emergency Team (MET) activations in hospital. Research on clinical deterioration has mostly focused on clinicians' roles. Although patients and families can identify subtle cues of early deterioration, little research has focused on their experience of recognising, speaking up and communicating with clinicians during this period of instability. A narrative inquiry. Using narrative interviewing techniques, 33 adult patients and 14 family members of patients, who had received a MET call, in one private and one public academic teaching hospital in Melbourne, Australia were interviewed. Narrative analysis was conducted on the data. The core story of help seeking for recognition and response by clinicians to patient deterioration yielded four subplots: (1) identifying deterioration, recognition that something was not right and different from earlier; (2) voicing concerns to their nurse or by family members on their behalf; (3) being heard, desiring a response acknowledging the legitimacy of their concerns; and (4) once concerns were expressed, there was an expectation of and trust in clinicians to act on the concerns and manage the situation. Clinical deterioration results in an additional burden for hospitalised patients and families to speak up, seek help and resolve their concerns. Educating patients and families on what to be concerned about and when to notify staff requires a close partnership with clinicians. Clinicians must create an environment that enables patients and families to speak up. They must be alert to both subjective and objective information, to acknowledge and to act on the information accordingly. The consolidated criteria for reporting qualitative research (COREQ) guidelines were used for reporting. The consumer researcher was involved in design, data analysis and publication preparation.

Simplifying Alzheimer's Disease Monitoring: A Novel Machine-Learning Approach to Estimate the Clinical Dementia Rating Sum of Box Changes Using the Mini-Mental State Examination and Functional Activities Questionnaire.

Primary outcome measure in the clinical trials of disease modifying therapy (DMT) drugs for Alzheimer's disease (AD) has often been evaluated by Clinical Dementia Rating sum of boxes (CDRSB). However, CDR testing requires specialized training and 30-50 minutes to complete, not being suitable for daily clinical practice. Herein, we proposed a machine-learning method to estimate CDRSB changes using simpler cognitive/functional batteries (Mini-Mental State Examination [MMSE] and Functional Activities Questionnaire [FAQ]), to replace CDR testing. Baseline data from 944 ADNI and 171 J-ADNI amyloid-positive participants were used to build machine-learning models predicting annualized CDRSB changes between visits, based on MMSE and FAQ scores. Prediction performance was evaluated with mean absolute error (MAE) and R2 comparing predicted to actual rmDeltaCDRSB/rmDeltayear. We further assessed whether decline in cognitive function surpassing particular thresholds could be identified using the predicted rmDeltaCDRSB/rmDeltayear. The models achieved the minimum required prediction errors (MAE < 1.0) and satisfactory prediction accuracy (R2>0.5) for mild cognitive impairment (MCI) patients for changes in CDRSB over periods of 18 months or longer. Predictions of annualized CDRSB progression>0.5, >1.0, or >1.5 demonstrated a consistent performance (i.e., Matthews correlation coefficient>0.5). These results were largely replicated in the J-ADNI case predictions. Our method effectively predicted MCI patient deterioration in the CDRSB based solely on MMSE and FAQ scores. It may aid routine practice for disease-modifying therapy drug efficacy evaluation, without necessitating CDR testing at every visit.

Correlation of LP-PLA2 and MMP-9 with the occurrence of early neurological deterioration in patients with acute ischemic stroke.

Early neurological deterioration is a common complication of acute ischemic stroke (AIS), which aggravates symptoms, worsens the condition, and counteracts the benefits of clinical treatment. The aim of this paper was to analyze the correlation between lipoprotein-associated phospholipase A2 (Lp-PLA2), matrix metalloproteinase-9 (MMP-9), and the occurrence of early neurological deterioration (END) in patients with AIS and to explore the clinical prediction of END by the combination of the 2 assays for the clinical prediction of END. A total of 500 AIS patients admitted to our hospital from October 2022 to October 2023 were included as study subjects, and the clinical data of all AIS patients were collected and organized to detect the levels of Lp-PLA2 and MMP-9. Categorized into END and non-END groups according to whether END occurred within 7 days of the onset of AIS, and comparing the clinical baseline data and laboratory index levels of the 2 groups. Logistic regression analysis was performed to determine the independent predictors of END, and the predictive effects of Lp-PLA2 and MMP-9 levels on END were assessed by subject work characteristics (ROC) curves. END occurred in 111 (22.2%) of 500 AIS patients. Multivariate logistic regression analysis showed that diabetes (OR 2.717, 95% CI:1.53-4.81, P < .001), baseline NIHSS score (OR 1.65, 95% CI:1.41-1.94, P < .001), Lp-PLA2 (OR 1.07, 95% CI:1.05-1.09, P < .001) and MMP-9 (OR 1.12, 95% CI:1.09-1.16, P < .001) levels were independent influences on the occurrence of END in patients with AIS after correcting for confounders. ROC curve analysis showed that Lp-PLA2, MMP-9, and a combination of both predicted END with an area under the curve was 0.730, 0.763, and 0.831, respectively, and the area under the curve for the combination of both predicting END was significantly higher than that for any of the inflammatory markers alone (P < .05). Both inflammatory markers, Lp-PLA2 and MMP-9, were independent predictors of the development of END in patients with AIS, and the combination of the two had a higher predictive value.

Influences of Leadership, Organizational Culture, and Hierarchy on Raising Concerns About Patient Deterioration: A Qualitative Study.

Raising concerns is essential for the early detection and appropriate response to patient deterioration. However, factors such as hierarchy, leadership, and organizational culture can impact negatively on the willingness to raise concerns. This study aims to delve into how leadership, organizational cultures, and professional hierarchies in healthcare settings influence healthcare workers, patients, and caregivers in raising concerns about patient deterioration and their willingness to do so. The study used a qualitative approach, conducting focus group discussions (N = 27), utilizing authentic audio-visual vignettes to prompt discussions about raising concerns. Deductive thematic analysis was employed to explore themes related to hierarchy, leadership, and organizational culture. Positive leadership that challenged traditional professional hierarchies by embracing multidisciplinary teamwork, valuing the input of all stakeholders, and championing person-centered practice fostered a positive working culture. This culture has the potential to empower clinical staff, patients, caregivers, and family members to confidently raise concerns. Staff development, clinical supervision, and access to feedback, all underpinned by psychological safety, were viewed as facilitating the escalation of concerns and, subsequently, have the potential to improve patient safety. This study offers crucial insights into the intricate dynamics of leadership, hierarchy, and organizational culture, and their profound impact on the willingness of staff and patients to voice concerns in healthcare settings. Prioritizing the recommendations of this study can contribute to reducing avoidable deaths and elevating the quality of care in healthcare settings.

Left ventricular global longitudinal strain is a long-term predictor of pacemaker-associated cardiomyopathy

Abstract Background Implantation of a permanent pacemaker is an effective treatment for symptomatic bradycardia. However, chronic right ventricular pacing (RVP) may lead to compromised left ventricular (LV) function, atrial fibrillation, heart failure, and increased mortality via pacing induced electrical and mechanical dyssynchrony. A decrease in LV ejection fraction (LVEF) of ≥ 10% with a baseline LVEF &amp;gt; 50% prior to RVP and no alternative explanation for the decline in LVEF is termed pacing-induced cardiomyopathy (PICM). Predictive clinical and imaging-derived measures to identify patients at high risk for pacemaker induced cardiomyopathy (PMIC) are lacking, but essential. Objective The study is a prospective, single center, double-blinded trial evaluating the impact of right ventricular pacing on left ventricular function and clinical outcome. Methods In 105 patients (59 male / 46 female), who underwent a dual-chamber pacemaker implantation at the Charité Campus Virchow Klinikum, RVP burden, LVEF and left ventricular global longitudinal strain (LV-GLS) were obtained. Mean follow-up per patient was 29.6 ±13.9 months. We used a stepwise analytic approach including ROC analysis, univariate testing, binary regression as well as Cox-regression models and Kaplan-Meier analysis to compare low RVP burden (&amp;lt; 30%) and high RVP burden (≥ 30%) cohorts according to change in echocardiographic parameters and clinical outcome (all-cause mortality). Results Mean LVEF was 61 ± 6% and mean LV-GLS was 18 ± 4% at baseline. We identified 7 patients with a LVEF decline in the course of the study. In Pearson’s Chi-squared test, patients with a high RVP burden were more likely to develop LVEF and LV-GLS deterioration (6 patients versus 1 patient for LVEF, p&amp;lt;0.05; 28 versus 16 patients for LV-GLS, p&amp;lt;0.001). In multivariable binary logistic regression, LV-GLS (OR: 1.410, 95% CI: 1.201-1.610, p&amp;lt;0.001) deterioration was significantly associated with a LVEF decline and a high RVP burden ≥ 30% (OR: 1.358, 95% CI: 1.160-1.534, p&amp;lt;0.01). In a log-rank test, time to LVEF decline was significantly shorter in patients with a RVP burden ≥ 30% compared to a RVP burden &amp;lt; 30% (45.2±2.9 versus 55.7±1.0 months, p&amp;lt;0.05). In the Cox-regression analysis, LV-strain decline within 12 months (HR: 7.210, 95% CI: 4.239-9.516, p&amp;lt;0.05) was a significant predictor for a later LVEF decline. In a log-rank test, time to LVEF deterioration was significantly shorter in patients with LV-strain decline within 12 months compared to those without (34.7 ± 4.2 versus 53.7 ± 1.4 months, p&amp;lt;0.001). No significant difference in all-cause mortality between patients with a high RVP burden compared to those with low RVP burden (log-rank test, p=0.2). Conclusion A decline in LV-GLS is a sensitive long-term parameter of subsequent LVEF deterioration in patients with normal preimplant LVEF, who require RVP ≥ 30%. and is associated with a poor clinical outcome.

P.134 Long-term quality of life deterioration in vestibular schwannoma patients treated with radiotherapy: a matched cohort with surveillance, radiation and surgery

Background: There is an absence of studies evaluating longitudinal quality of life (QoL) amongst vestibular schwannomas (VS) with matched tumor and patient characteristics between treatment groups. We present novel findings of 12 yearlong follow-up of patient QoL and symptomatology outcomes in this matched cohort study. Methods: Symptomatology and 36-Item Short Form Health Survey (SF36) between 2000-2017 in VS patients managed at a single tertiary centre was conducted. Radiation (R) and active surveillance (A) groups were matched for tumor size and age against the surgery (S) group. Results: 14 A patients, 24 R patients, 49 S patients met matching and inclusion criteria. Mean age, tumor diameter and follow up was 69.1 years, 21.6mm and 12.0 years respectively. Mental component summary (MCS) scores deteriorated significantly in the radiation group (3.1 S, 3.7 A, -3.5 R, p-value 0.008). Physical component summary scores remained stable at follow up (-0.2 S, 0.00 S, -4.0 R, p-value 0.227). Various symptoms resolved statistically in surgery goup, whereas tinnitus on follow up was higher with radiation (40.8% S, 66.7% R, p-value 0.038). Conclusions: Surgery group demonstrated improvements in long term QoL with good symptom resolution, whilst radiation group demonstrated small but significant deterioration over time.

E.4 Machine learning based patient classification to predict neurological deterioration in mild Degenerative Cervical Myelopathy

Background: Degenerative Cervical Myelopathy (DCM) is the functional derangement of the spinal cord because of compression from degenerate tissues. Typical neurological symptoms of DCM include gait imbalance and upper extremity paresthesia. While it is thought that greater spinal cord compression leads to increased neurological deterioration, our clinical experience suggests a more complex mechanism involving spinal canal diameter (SCD). Methods: 124 MRI scans from 59 non-operative DCM patients underwent manual scoring of cord compression and SCD measurements. Unsupervised machine learning dimensionality reduction techniques and k-means clustering were used to establish patient groups. These patient groups underwent manual inspection of common compression patterns and SCD similarities to define their unique risk criteria. Results: We found that compression pattern is unimportant at SCD extremes (≤14.5 mm or &gt;15.75 mm). Otherwise, stenosis with clear signs of cord compression at two disc levels and stenosis without clear signs of cord compression at two disc levels result in a relatively higher and lower likelihood of deterioration, respectively. We elucidated five patient groups with unique associated risks for neurological deterioration, according to both SCD range and their cord compression pattern. Conclusions: The specific combination of narrow SCD with focal cord compression increases the likelihood of neurological deterioration in non-operative patients with DCM.

#2459 Matching-adjusted indirect comparison of eGFR in patients with immunoglobulin A nephropathy treated with Nefecon (TRF budesonide) or sparsentan

Abstract Background and Aims Primary immunoglobulin A nephropathy (IgAN) is an immune-mediated disease that can lead to kidney failure, need for dialysis and kidney transplantation, and early death. IgAN is the most common type of primary glomerulonephritis globally, with an estimated worldwide incidence of 2.5 per 100 000 individuals per year. Estimated glomerular filtration rate (eGFR) is a measure of renal function and is accepted as a surrogate endpoint for clinical trials evaluating kidney function deterioration. In December 2023, the US Food and Drug Administration (FDA) granted full approval to Nefecon (marketed as Tarpeyo® by Calliditas Therapeutics), a targeted-release formulation of budesonide, to reduce the loss of kidney function in adults with IgAN at risk of disease progression, based on the Phase 3 NefIgArd clinical trial. In February 2023, sparsentan (marketed as Filspari™ by Travere Therapeutics) was granted accelerated approval by the FDA to reduce proteinuria in adults with primary IgAN at risk of rapid disease progression, generally a urine protein–creatinine ratio (UPCR) ≥1.5 g/g, based on the Phase 3 PROTECT study. Matching-adjusted indirect comparison (MAIC) is a widely accepted and relevant methodology for comparing treatments across trials in the absence of head-to-head comparisons. In this analysis, we aimed to compare the effects of Nefecon and sparsentan on kidney function deterioration in patients with IgAN, as assessed by eGFR. Method An anchored MAIC was performed to estimate the relative effect of Nefecon and sparsentan on the absolute eGFR change from baseline at 9, 12 and 24 months, with common comparators of optimized renin–angiotensin system inhibition for NefIgArd and irbesartan for PROTECT. Patient-level data from NefIgArd were used to select a population matched to PROTECT, and the following baseline characteristics were used to determine the weights: mean age (years), sex (% male), race (% white), mean eGFR (mL/min/1.73 m2), mean UPCR (g/g), urine albumin–creatinine ratio (UACR) (% with UACR &amp;gt;1.1 g/g), and urinary protein excretion (% with urinary protein excretion &amp;gt;1.8 g/day). Absolute change in eGFR was analyzed using a mixed model for repeated measures (MMRM) method, including baseline, 3-, 6-, 9-, 12-, 18- and 24-month data, baseline eGFR, baseline eGFR-by-time interaction, treatment, and treatment-by-time interaction. The MAIC weights were incorporated into the MMRM. A Bayesian fixed-effects network meta-analysis was performed on the relative effect from PROTECT and the weighted relative effect from NefIgArd, measured by the estimated absolute change from baseline in eGFR. Results The matching-adjustment of the NefIgArd patient population to the PROTECT population is shown in Table 1. The weighted NefIgArd population exhibits very similar baseline characteristics to the PROTECT population. The effective sample size of the weighted NefIgArd population is 208. Results from the anchored MAIC showed statistically and clinically significant favorable effects of Nefecon versus sparsentan on eGFR for all time points analyzed (Fig. 1). Mean differences in the absolute change in eGFR of 5.68 mL/min/1.73 m2 (95% credible interval [Crl] 3.14, 8.20; p &amp;lt; 0.001), 3.48 mL/min/1.73 m2 (95% Crl 0.97, 5.97; p = 0.006) and 3.28 mL/min/1.73 m2 (95% Crl 0.02, 6.51; p = 0.048) were observed when comparing Nefecon with sparsentan at 9 months vs 36 weeks, 12 months vs 48 weeks, and 24 months vs 106 weeks, respectively. Conclusion After accounting for differences in the patient populations from the NefIgArd and PROTECT trials, the anchored MAIC showed that treatment with Nefecon 16 mg/day for 9 months was associated with greater eGFR benefit compared with continuous treatment with sparsentan 400 mg/day over 2 years, with significant differences observed as early as 9 months after treatment initiation and sustained up to 2-years of follow-up.

Impact of Acute Exacerbation of Idiopathic Pulmonary Fibrosis on Lung Transplant Outcomes.

Acute exacerbations of idiopathic pulmonary fibrosis (AE-IPF) are acute, significant respiratory deteriorations in patients with IPF and can lead to increased morbidity and mortality. It remains unclear how AE-IPF impacts lung transplant (LTX) outcomes. All adult patients who were listed for LTX between July 2005 and October 2020 at the Loyola University Medical Center with a diagnosis of IPF were included. Pretransplant characteristics and posttransplant outcomes were gathered via retrospective chart review. The primary outcome was short- and long-term survival for patients transplanted during stable IPF versus those with AE-IPF. One hundred fifty-nine patients were included in this study, 17.6% of whom were transplanted during AE-IPF. AE-IPF patients were more likely to have higher oxygen needs pretransplant, have higher lung allocation score, and were more likely to be intubated or be on extracorporeal membrane oxygenation as compared with stable IPF patients. Survival by AE status at transplant did not differ at 90 d or 1 y posttransplantation. There were also no significant differences in rates of severe primary graft dysfunction or acute rejection within 1 y. Patients with AE-IPF were more likely to have higher oxygenation requirements and higher lung allocation score at the time of LTX than those with stable IPF. Despite this, there were no differences in survival at 90 d, 1 y, or 3 y, or differences in incidence of severe primary graft dysfunction or acute cellular rejection. Transplantation of patients with AE-IPF has clinical outcomes comparable with transplantation of patients with stable IPF. This contrasts with previous studies examining LTX in patients with AE-IPF.

“Pre-Discharge Syndrome” in Gerontopsychiatric Practice: Clinical Manifestations and Risk Factors

Background: hospitalization of elderly patients is associated with social and psychological maladaptation, reduced levels of daily functioning, and development of hospitalism. Patients whose status suddenly worsened immediately prior to discharge from psychiatric hospital make up a group that is difficult for diagnostics and treatment and not sufficiently studied. The aim of the study was to analyze changes in patients’ status before planned discharge from hospital to identify clinical patterns of deterioration and factors associated with this adverse event. Patients and methods: study participants were selected from 181 consecutive patients of the Geriatric Psychiatry Department of V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology. The main study methods were history-taking and psychological assessment. Results: predischarge deterioration was observed in 81 patients (44.8%) and was represented by exacerbation of mental disorder in 60 cases (33.2%), development of new symptoms in 12 patients (6.6%), or decompensation of somatic disease in 9 cases (5.0%). The history of patients with predischarge worsening was characterized by longer prior hospitalizations. These patients were more heavily pretreated, and had higher rates of hospitalism and non-compliance. For patients with worsening or development of new symptoms of mental disorder median duration of mental disease was respectively 84 and 204 months. They were more prone to violation of compliance, of the prescribed treatment regime and doses. Somatic decompensation occurred in patients with median duration of mental disorder 36 months and was associated with latent refusal to take medicines. Conclusions: an increased risk of predischarge deterioration in geropsychiatric patients with a history of prolonged hospitalizations needs earlier rehabilitation, psychotherapy, and psychological support when planning hospital discharge.