Factor For Mortality In Patients Research Articles

Assessing sex differential in COVID-19 mortality rate by age and polymerase chain reaction test results: an Iranian multi-center study

ABSTRACT Background The aim of this study is to evaluate the sex differential effect in the COVID-19 mortality by different age groups and polymerase chain reaction (PCR) test results. Research design In a multicenter cross-sectional study from 55 hospitals in Tehran, Iran, patients were categorized as positive, negative, and suspected cases. Results A total of 25,481 cases (14,791 males) were included in the study with a mortality rate of 12.0%. The mortality rates in positive, negative, and suspected cases were 20.55%, 9.97%, and 7.31%, respectively. Using a Cox regression model, sex had a significant effect on the hazard of death due to COVID-19 in adult and senior male patients having positive and suspected PCR test results. However, sex was not found as significant factor for mortality in patients with a negative PCR test in different age groups. Conclusions Regardless of other risk factors, we found that the effect of sex on COVID-19 mortality varied significantly in different age groups. Therefore, appropriate strategies should be designed to protect adult and senior males from this deadly infectious disease. Furthermore, owing to the considerable death rate of COVID-19 patients with negative test results, new policies should be launched to increase the accuracy of diagnosis tests.

Diabetes as a predictive factor for severe form and high mortality risk of COVID-19: Retrospective cohort study of 188 cases

IntroductionSince the appearance of the first case of the SARS CoV 2 infection, several studies have been conducted to identify the predictive factors of mortality in patients with COVID-19. According to previous reports, diabetes seems to be associated with severe clinical forms of the new coronavirus (SARS CoV 2).Our study aimed to identify the epidemiological, clinical, radiological and prognostic profile of diabetic patients with COVID-19. MethodsThis retrospective study included diabetic patients diagnosed with COVID-19 and admitted to the Resuscitation Department of our university hospital center From Mars 1st 2020, to December 31st, 2020. Results and discussionIn this study, we collected the data of 600 patients admitted to the Anesthesia and Resuscitation Department of the Mohammed VI University Hospital of Oujda, a group of 188 (31.3%) had diabetes.The median age of our patients was 67 [25–75]. Were noted in the majority, of patients 69.6% with diabetes have developed a severe or critical injuries in the Chest CT Scan. Furthermore, we found that the mortality rate in this category of patients was higher 65/188 (34.60%) compared to non-diabetic patients, 130/412 (31.60%) (34.60%vs 31.60%; p: 0.464). ConclusionBased on the results of this retrospective study, we concluded that diabetes is predictive factor for the need of an intensive care as well as a high risk of mortality related to COVID-19.Practically speaking, diabetic patients should be monitored more closely and need an aggressive preventive management protocols in order to prevent severe forms of the disease and a drastic evolution.More research is direly needed to identify patients of a higher risk of developing severe forms of COVID-19.

OR55. Risk Factor For Mortality Of Patients Waiting For Elective Coronary Artery Bypass Graft Surgery

Abstract Background and Aims Insufficient capacity for cardiac surgery results in extensive waiting time of patients requiring coronary artery bypass grafting (CABG). Previous studies have reported a consequence of an increased risk of mortality while waiting for CABG. Identification of mortality rates and risk factors for mortality is important in patients waiting for CABG. Methods and results This retrospective cohort study was done on patients awaiting for elective CABG in dr. Kariadi General Hospital from January 2018 to December 2020. Identification of risk factors that associated with mortality was done on patients who were waiting CABG using logistic regression methods. There were 162 patients fulfilling the criteria, with a mean waiting time for an operation of 9.8 months. While waiting for CABG surgery, 32 (19.7%) patients died of any cause. Independent risk factors for death while waiting for CABG included : left ventricular ejection fraction < 45% (OR 4.75; 95% CI 1.76-12.78; p = 0.002), left main disease (OR 4.12; 95% CI 1.50-11.27; p = 0.006), serum creatinin > 1.5 mg/dl (OR 3.71; 95% CI 1.41-9.74; p = 0.008), and number of coronary artery disease risk factor > 3 (OR 3.34; 95% CI 1.24-8.99; p = 0.017). Conclusions Long waiting lists for CABG is associated with high mortality rate which is influenced by left ventricular ejection fraction < 45%, left main disease, serum creatinin > 1.5 mg/dl, and number of coronary artery disease risk factor > 3.

Clinical characteristics and prognostic risk factors of mortality in patients with interstitial lung diseases and viral infection: a retrospective cohort study.

IntroductionPatients with interstitial lung disease (ILD) who subsequently develop a viral infection have high rates of morbidity and mortality.Hypothesis/Gap statementFew large-scale epidemiological studies have investigated potential prognostic factors for morbidity and mortality in this patient group.AimTo evaluate the risk factors for morbidity and mortality in hospitalized patients with ILD and viral infection, as well as the clinical characteristics.MethodologyThis retrospective cohort study included patients with ILD who were hospitalized for a viral infection in two tertiary academic hospitals in China, between 1 January 2013 and 31 December 2019. We analysed the prevalence of comorbidities, clinical characteristics, 30 day mortality rates, and prognostic risk factors.ResultsA total of 282 patients were included; 195 and 87 were immunocompromised and immunocompetent, respectively. The most common underlying interstitial diseases were idiopathic pulmonary fibrosis (42.9 %) and connective tissue disease (36.9 %). The 30 day mortality rate was 20.6 %. During the influenza season, an increase in influenza virus (IFV) (25.7 %), respiratory syncytial virus (14.9 %) and cytomegalovirus (CMV) (11.3 %) cases was observed in the immunocompromised group. The most frequently detected virus in the immunocompetent group was IFV (44.8 %), followed by respiratory syncytial virus (11.5 %), and human rhinovirus (9.2 %). During the non-influenza season, CMV (34.4 %) was the main virus detected in the immunocompromised group. The 30 day mortality rates of non-IFV patients were higher than those of IFV patients. Older age (>60 years), respiratory failure, persistent lymphocytopenia, invasive mechanical ventilation and non-IFV virus infection were significantly associated with increased 30 day mortality.ConclusionPatients with ILD who develop viral infection have high rates of morbidity and mortality, which are associated with increased age (>60 years), respiratory failure, mechanical ventilation, persistent lymphocytopenia and non-IFV virus infection. These risk factors should be carefully considered when determining treatment strategies for this patient population.

Association of methicillin resistance with mortality of hospital-acquired Staphylococcus aureus bacteremia.

ObjectiveMethicillin-resistant (MR) Staphylococcus aureus bacteremia (SAB) is associated with higher mortality rates than methicillin-susceptible (MS) SAB. This study assessed potential predictors of mortality and evaluated the association of methicillin resistance with mortality in patients with SAB.MethodsWe conducted a retrospective cohort study in patients with hospital-acquired SAB, from 2009 to 2018. Clinical features of patients with MR-SAB were compared with those of patients with MS-SAB and predictors of 30-day mortality were determined using Cox regression analysis.ResultsAmong 162 patients, 56.8% had MR-SAB. Overall 30-day mortality was 19.1%; MR-SAB had higher mortality (25.0%) than MS-SAB (11.4%). Univariate analysis highlighted long-term hospitalization, prior antibiotics use, and delayed initiation of appropriate antibiotics as risk factors. Cox regression analysis showed that respiratory tract source, Pitt bacteremia score, Charlson comorbidity index, and appropriate antibiotic therapy within 24 hours were independently and significantly associated with 30-day mortality outcome.ConclusionsMethicillin resistance was not an independent risk factor for mortality in patients with SAB. Early, appropriate antibiotic treatment is an important prognostic factor.

Evaluation of Cardiovascular Diseases and Diabetes Mellitus as Predisposing Factors for Mortality in Patients with Coronavirus Disease 2019: Systematic Review and Meta-Analysis

BackgroundCoronavirus disease 2019 (COVID-19) has long-lasting effects on health, social well-being, and national economies worldwide because of its high infection and mortality rates. The risk is especially high in patients with cardiovascular diseases (CVD) and diabetes mellitus (DM). Objective: To analyse the association of CVD and DM with mortality in patients infected with COVID-19. MethodsA systematic review of the Medline, PubMed, Embase, SciELO and Cochrane Collaboration Library was performed to determine pertinent studies conducted and published from December 2019 to October 2020. Study selection, data extraction and quality assessment, data synthesis and analysis, and determination of risk of bias were conducted by 2 pairs of reviewers in a double-blinded manner. The risk of bias and heterogeneity between studies was evaluated using the Cochrane system and Q-test. A random-effects model was used to evaluate results with Revman 5.3 software. ResultsA total of 11 studies with total of 5032 patients (including 286 with CVD and 532 with DM) were recruited and analysed. Meta-analysis revealed that DM was moderately related to mortality of COVID-19: [odds-ratio (OR) 2.50, 95% confidence interval (CI) 1.70-3.60; p=0.032] and CVD was significantly related to mortality for COVID-19 (OR 6.30, 95% CI 3.70-10.80, p=0.074). Conclusion: In conclusion, DM and particularly CVD are significant predisposing factors for mortality in patients with COVID-19. Meticulous evaluation of these patients must be performed for better management.

Risk factors for 30-day mortality in patients who received DeBakey type I aortic dissection repair surgery

ObjectiveThis study aimed to identify risk factors for 30-day mortality in patients who received DeBakey type I aortic dissection (AD) repair surgery.MethodsA total of 830 consecutive patients who received acute DeBakey type I AD surgery between 2014 and 2019 were included in the study. The associations between 30-day mortality and perioperative parameters were examined in order to identify risk factors.ResultsOur data suggested that the overall 30-day mortality rate of all enrolled patients was 11.7%. Unsurprisingly, non-survivors were older and more frequently accompanied with histories of cardiovascular diseases. For intraoperative parameters, the prevalence of coronary artery bypass grafting and cardiopulmonary bypass times were increased in non-survivors. In addition, acute kidney injury (AKI), dialysis, stroke, and deep sternal wound infection were more commonly seen among non-survivors. The multivariate logistic regression analysis suggested that cardiovascular disease history, preoperative D-dimer level, drainage volume 24 h after surgery, and postoperative AKI were independent risk factors for 30-day mortality after DeBakey type I aortic dissection repair surgery.ConclusionsOur study demonstrated that cardiovascular disease history, preoperative D-dimer level, drainage volume 24 h after surgery as well as postoperative AKI were risk factors for 30-day mortality after DeBakey type I aortic dissection repair surgery.

High Glucose Variability Increases Mortality Risk in Patients with COVID-19

BackgroundIn patients with COVID 19, with or without history of diabetes, having hyperglycemia is an important factor in mortality; approximately 45.2% of patients with this disease have elevated blood glucose levels. Glucose variability (GV) has also been shown to be an independent predictor of mortality in critically ill patients. A patient is considered uncontrolled if he/she has a value above 36%. Objective: To determine whether GV is a prognostic factor for mortality in patients with COVID-19 admitted to the Intensive Care Unit (ICU) MethodsAll patients with positive PCR for COVID-19, who were admitted to the ICU of the Guatemalan Institute of Social Security during the months of May and June 2021, were subjected to glycosylated hemoglobin and periodic serum glucose samples to calculate the GV, using the coefficient of variation of glucose. ResultsTo determine the normality of the sample, the Kolmogorov-Smirnov statistic was used, after that, it was determined which variables to include in the statistical model, Student's t-test was used for quantitative variables and chi-square for categorical variables. The following variables were included in the final model: Sex, History of diabetes, Glycosylated Hemoglobin, and GV (p=<0.05), the model predicts between 69 and 97%, according to Cox and Snell and Nagelkerke's R-squared values. Conclusions: Having VG above 36% is associated with mortality in patients with COVID-19 admitted to the ICU.

The effect of aspirin in patients with nonvaricose upper gastrointestinal bleeding and risk factors analysis

Objective This paper aims to explore the effect of aspirin on the in-hospital mortality of patients with NVUGIB. Methods An observational study retrospectively examined 1514 patients with NVUGIB based on a multi-center database. Result Our study reported a mortality rate of 4.8% in patients with NVUGIB, with 163 patients had a history of aspirin. Among 163 patients with an aspirin history, 76 patients (46.6%) continued to take aspirin in the hospital, with an average duration of 0.66 days after bleeding. Subsequent multivariate regression analysis showed heart rate (p <.001, OR = 0.978, 95%CI 0.969–0.987) and albumin (p =.019, OR = 0.658, 95%CI 0.464–0.933) were independent factors for aspirin-therapy after bleeding. Patients who received aspirin after NVUGIB (log-rank = 3.968, p =.046) had better survival than those who did not, but it was not an independent risk factor. The levels of albumin (p < .001, OR = 0.288, 95%CI 0.165–0.505) and INR (p =.013, OR = 1.166, 95%CI 1.033–1.316) and heart rate (p =.005, OR = 1.017, 95%CI 1.005–1.029) were independent factors of in-hospital mortality. Conclusions The independent risk factors for in-hospital mortality in patients with NVUGIB were albumin and INR and heart rate. The history of aspirin and the aspirin therapy after the bleeding did not affect the in-hospital mortality in patients with NVUGIB.

Risk factors for mortality in patients undergoing continuous renal replacement therapy after cardiac surgery

BackgroundTo investigate the risk factors for mortality in patients with acute kidney injury requiring continuous renal replacement therapy (AKI-CRRT) after cardiac surgery.MethodsIn this retrospective study, patients who underwent AKI-CRRT after cardiac surgery in our centre from January 2015 to January 2020 were included. Univariable and multivariable analyses were performed to identify the risk factors for in-hospital mortality.ResultsA total of 412 patients were included in our study. Of these, 174 died after AKI-CRRT, and the remaining 238 were included in the survival control group. Multivariable logistic regression analysis revealed that EuroSCORE > 7 (odds ratio [OR], 3.72; 95% confidence interval [CI], 1.92–7.24; p < 0.01), intraoperative bleeding > 1 L (OR, 2.14; 95% CI, 1.19–3.86; p = 0.01) and mechanical ventilation time > 70 h (OR, 5.03; 95% CI, 2.40–10.54; p < 0.01) were independent risk factors for in-hospital mortality in patients who had undergone AKI-CRRT. Our study also found that the use of furosemide after surgery was a protective factor for such patients (odds ratio, 0.48; 95% confidence interval, 0.25–0.92; p = 0.03).ConclusionsIn summary, the mortality of patients with AKI-CRRT after cardiac surgery remains high. The EuroSCORE, intraoperative bleeding and mechanical ventilation time were independent risk factors for in-hospital mortality. Continuous application of furosemide may be associated with a better outcome.

Neutrophil-Lymphocyte Ratio as a Prognostic Factor for 15-Day Mortality of Patients infected in ICU

Abstract Introduction The determination of the groups at risk of death at admission in patients with bacterial infection in the ICU is important. Several prognostic factors have already been identified, however the neutrophil/lymphocyte ratio (NLR) has the advantage of being common and inexpensive. Objective To determine the threshold value of NLR to determine the group at risk of 15-day mortality and the overall survival of patients according to this threshold. Methods This was a retrospective cohort conducted in the intensive care unit of the Ibn Rochd University Hospital in Casablanca over a period of 2 years (January 2019 - January 2021), among hospitalized patients with bacterial infection, acquired or nosocomial. The sample size was calculated a priori and multivariate statistical analyses (multiple logistic regression, Youden index and Kaplan Meier survival estimation and Log Rank) were performed using Rstudio software. The significance level was less than 5%. Results A total of 200 patients were included in the study, 136 patients were alive at 15 days, there were no differences in age between the two groups. Factors associated with patient mortality at 15 days were: gender, use of vasoactive drugs, use of mechanical ventilation, type of sepsis, site of infection, SOFA score (p &amp;lt; 0.000), Apache score (p = 0.009) and NLR at admission (p = 0.001). The cut-off value for NLR was 15.07 with a mean discriminant value of 64.1%. The difference in median overall survival of patients in the two groups according to the threshold value was statistically significant 22 +/- 1.9 days and 11 +/-1.12 days (p = 0.042). Conclusions The NLR appears to be a prognostic factor for 15-day mortality. The knowledge of prognostic factors and threshold values of these indicators allow the prediction of at-risk groups in order to best adapt their management. Key messages The use of common and inexpensive biological prognostic markers are a reliable alternative to identify at-risk patients to optimize their management in developing countries. The RNL is a good biological prognostic markers of mortality of patients infected in ICU.

Predictors of in-hospital mortality, 20-year survival and reflection on risk scoring in patients with impaired left ventricular function undergoing isolated coronary artery bypass grafting

Abstract Background Impaired left ventricular ejection fraction (LVEF) is a risk factor for mortality in patients undergoing coronary artery bypass grafting (CABG). Limited data is available on survival after 5 years and sensitivity of preoperative risk scoring systems in this high-risk population. Purpose To investigate in-hospital mortality, 20-year survival, predictors of early and late mortality and sensitivity of available risk-scoring systems in a large population with moderate to poor baseline LVEF and undergoing isolated CABG. Methods Patients presenting with moderate to poor LVEF and undergoing isolated CABG between 1996 and 2015 were selected for the purpose of this study. LVEF was defined moderate if between 30–39% and poor if &amp;lt;30%. Data collection was prospective and retrospectively analysed. Early and long-term mortality was derived from the NHS National Mortality Tracking system. Exclusion criteria included reoperations and combined procedures only. Patients undergoing urgent and emergency CABG procedures were included. Key outcome measures included 30-day health outcome, long-term survival, impact of incomplete revascularization (IC) and off-pump coronary artery bypass (OPCAB) surgery, independent predictors of poor in-hospital outcome and long-term mortality and reliability of Euroscore in predicting mortality in this high-risk population. Comparative analysis was conducted with Student t-test or Mann-whithney test fro numerical variable and Chi-Square for categorical variables. Survival were compared and reported using Log rank test and Kaplan Meier methods. A Cox Proportional Hazard model was developed to identify risk factors for long term mortality. Results 5016 patients with reduced LVEF were identifiedL1024 (20.4%) with poor and 3992 (79.6%) with moderate LVEF. After excluding reoperations and combined procedures, the final sample consisted of 3867 patients. Average age was68 years, 83% were male, 40% had NYHA IV; 12.5% of patients received IC and 44% underwent OPCAB surgery. 30-day mortality was 4.4%, stroke 1.4% and renal failure requiring dialysis of 2.9%. Survival at 1, 5, 10 and 20 years was 91.1%, 76.7%, 55.1% and 22.1% respectively (Figure). OPCAB surgery was not associated with long-term mortality. Independent predictors of late mortality as shown in Table. Additive Euroscore and Logistic Euroscore appeared to overestimate mortality in this patient population (AUC 0.78). Conclusions In patients with reduced LVEF the use of CABG is associated with low rates of in-hospital mortality, key post-operative complications and excellent long-term survival. Incomplete revascularization but not OPCAB surgery are surgical predictors of long-term mortality. Euroscore appears to overestimate the risk of mortality in this population. Funding Acknowledgement Type of funding sources: None. Cox Hazard Ratio Table

Predictors of Mortality, Withdrawal of Life-Sustaining Measures, and Discharge Disposition in Octogenarians with Subdural Hematomas

Risk factors for mortality in patients with subdural hematoma (SDH) include poor Glasgow Coma Scale (GCS) score, pupil nonreactivity, and hemodynamic instability on presentation. Little is published regarding prognosticators of SDH in the elderly. This study aims to examine risk factors for hospital mortality and withdrawal of life-sustaining measures in an octogenarian population presenting with SDH. A prospectively collected multicenter database of 3279 traumatic brain injury admissions to 45 different U.S. trauma centers between 2017 and 2019 was queried to identify patients aged >79 years old presenting with SDH. Factors collected included baseline demographic data, past medical history, antiplatelet/anticoagulant use, and clinical presentation (GCS, pupil reactivity, injury severity scale [ISS]). Primary outcome data included hospital mortality/discharge to hospice care and withdrawal of life-sustaining measures. Multivariate logistic regression analyses were used to identify factors independently associated with primary outcome variables. A total of 695 patients were isolated for analysis. Of the total cohort, the rate of hospital mortality or discharge to hospice care was 22% (n= 150) and the rate of withdrawal of life-sustaining measures was 10% (n=66). A multivariate logistic regression model identified GCS <13, pupil nonreactivity, increasing ISS, intraventricular hemorrhage, and neurosurgical intervention as factors independently associated with hospital mortality/hospice. Congestive heart failure (CHF), hypotension, GCS <13, and neurosurgical intervention were independently associated with withdrawal of life-sustaining measures. Poor GCS, pupil nonreactivity, ISS, and intraventricular hemorrhage are independently associated with hospital mortality or discharge to hospice care in patients >80 years with SDH. Pre-existing CHF may further predict withdrawal of life-sustaining measures.

Long-term survival of mechanically ventilated patients with severe COVID-19: an observational cohort study

BackgroundInformation is lacking regarding long-term survival and predictive factors for mortality in patients with acute hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19) and undergoing invasive mechanical ventilation. We aimed to estimate 180-day mortality of patients with COVID-19 requiring invasive ventilation, and to develop a predictive model for long-term mortality.MethodsRetrospective, multicentre, national cohort study between March 8 and April 30, 2020 in 16 intensive care units (ICU) in Spain. Participants were consecutive adults who received invasive mechanical ventilation for COVID-19. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection detected in positive testing of a nasopharyngeal sample and confirmed by real time reverse-transcriptase polymerase chain reaction (rt-PCR). The primary outcomes was 180-day survival after hospital admission. Secondary outcomes were length of ICU and hospital stay, and ICU and in-hospital mortality. A predictive model was developed to estimate the probability of 180-day mortality.Results868 patients were included (median age, 64 years [interquartile range [IQR], 56–71 years]; 72% male). Severity at ICU admission, estimated by SAPS3, was 56 points [IQR 50–63]. Prior to intubation, 26% received some type of noninvasive respiratory support. The unadjusted overall 180-day survival rates was 59% (95% CI 56–62%). The predictive factors measured during ICU stay, and associated with 180-day mortality were: age [Odds Ratio [OR] per 1-year increase 1.051, 95% CI 1.033–1.068)), SAPS3 (OR per 1-point increase 1.027, 95% CI 1.011–1.044), diabetes (OR 1.546, 95% CI 1.085–2.204), neutrophils to lymphocytes ratio (OR per 1-unit increase 1.008, 95% CI 1.001–1.016), failed attempt of noninvasive positive pressure ventilation prior to orotracheal intubation (OR 1.878 (95% CI 1.124–3.140), use of selective digestive decontamination strategy during ICU stay (OR 0.590 (95% CI 0.358–0.972) and administration of low dosage of corticosteroids (methylprednisolone 1 mg/kg) (OR 2.042 (95% CI 1.205–3.460).ConclusionThe long-term survival of mechanically ventilated patients with severe COVID-19 reaches more than 50% and may help to provide individualized risk stratification and potential treatments.Trial registration: ClinicalTrials.gov Identifier: NCT04379258. Registered 10 April 2020 (retrospectively registered)

Analysis of clinical features and risk factors for mortality in patients with culture-negative sepsis: a single-center retrospective cohort study based on MIMIC-IV

To compare the characteristics and outcomes of culture-positive sepsis (CPS) with culture-negative sepsis (CNS) patients in order to understand the impact of CNS on prognosis and explore the possible risk factors for mortality. A retrospective cohort study was conducted. Patients with sepsis were identified from the Medical Information Mart for Intensive Care database-IV v0.4 (MIMIC-IV v0.4). Patients were divided into CPS and CNS groups according to the culture results within 24 hours before and after the diagnosis of sepsis. General information, baseline characteristics, and medical operation data between CNS and CPS groups were compared. Logistic regression analysis was used to calculate the relationship between CNS and in-hospital mortality under three regression models. Chi-square analysis and mediation analysis were used to analyze the effect of initial antibiotic and prior antibiotic use within 90 days on the in-hospital mortality of CNS. A total of 8 587 patients with sepsis were enrolled in the final analysis, including 5 483 patients in the CPS group and 3 104 patients in the CNS group. Compared with the CPS group, the patients in the CNS group were younger [years old: 68 (56, 79) vs. 70 (58, 81)], had higher sequential organ failure assessment (SOFA) score and higher proportion of using mechanical ventilation, renal replacement therapy and vasopressin within 24 hours after intensive care unit (ICU) admission [SOFA score: 3 (2, 5) vs. 3 (2, 4), mechanical ventilation: 48.61% (1 509/3 104) vs. 39.25% (2 152/5 483), renal replacement therapy: 13.69% (425/3 104) vs. 9.68% (531/5 483), vasopressin: 15.79% (490/3 104) vs. 13.44% (737/5 483)], longer length of ICU stay [days: 5 (3, 10) vs. 3 (2, 6)] and higher in-hospital mortality [25.00% (776/3 104) vs. 18.53% (1 016/5 483)], with significant differences (all P < 0.01). However, there was no significant difference in gender, ICU type, simplified acute physiology score II (SAPS II), and Charlson comorbidity index (CCI) score between the two groups. After adjustment for multiple confounding factors, CNS was still a risk factor for in-hospital mortality [odds ratio (OR) = 1.441, 95% confidence interval (95%CI) was 1.273-1.630, P < 0.001]. The results of Chi-square analysis and mediation analysis showed that the initial antibiotic had no significant effect on the higher in-hospital mortality of CNS, while the prior use of antibiotics within 90 days was related to higher in-hospital mortality of CNS (OR = 1.683, 95%CI was 1.328-2.134, P < 0.05). The mediating effect of CNS in prior antibiotic use within 90 days and in-hospital death was significant (Z = 5.302, P < 0.001), accounting for 7.58%. Compared with CPS, CNS was more severe and had a worse prognosis. Prior use of antibiotics within 90 days may be related to the higher in-hospital mortality of CNS patients, but it could not fully explain the high mortality of CNS.

Post–Cardiac Surgery Acute Mesenteric Ischemia in a Tertiary Referral Center

Post–cardiac surgery acute mesenteric ischemia (PCS AMI) is a rare, but catastrophic, complication. We investigated the risk factors for mortality in patients with PCS AMI at a tertiary referral center.

Low postoperative blood platelet count may be a risk factor for 3-year mortality in patients with acute type A aortic dissection

BackgroundMortality and complications remain high after acute type A aortic dissection (ATAAD) open surgery and are associated with coagulation dysfunction. Platelets play an important role in the process of coagulation. This study explored the relationship between postoperative platelet counts and 3-year mortality after operation in patients with ATAAD undergoing open aortic repair surgery.MethodsPatients with ATAAD who underwent Total Arch Replacement and Frozen Elephant Trunk in Fuwai Hospital from 2011 to 2015 were selected for this study. The perioperative data were collected and sorted through the electronic clinical case system. Multivariate Logistic regression was used to analyze the risk factors for death within three years after surgery.ResultsA total of 495 patients were included in the analysis. After correction for confounding factors, decreased postoperative platelet count remained an independent factor that was associated with lower mortality (OR = 0.918, 95% CI 0.853–0.988, P = 0.023).ConclusionsThe study indicated that decreased postoperative platelet count may lead to increased 3-year mortality, in patients with ATAAD who underwent open aortic repair surgery.

734 PL11.06 PROGNOSTIC FACTORS FOR MORTALITY IN PATIENTS WITH ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY FOR CANCER (TENTACLE—ESOPHAGUS STUDY)

Abstract Anastomotic leakage (AL) is a common and potentially life-threatening complication after esophagectomy. In patients with AL it is largely unknown which patient parameters and leakage characteristics are associated with leak severity and mortality. We aimed to identify prognostic factors for mortality in patients with anastomotic leakage after esophagectomy. Methods The TENTACLE—Esophagus study is an international retrospective cohort study, in which 1451 patients with AL after esophagectomy between 2011 and 2019 were included in 71 centers from 20 countries. Potential prognostic factors were selected from literature and a hypothetical association with mortality. Confounders of (individual) prognostic factors were identified using a directed acyclic graph approach to minimize bias. Primary outcome was 90-day mortality. Logistic regression analysis was performed to estimate crude and adjusted odds ratios (AOR) and 95% confidence intervals (95%CI). The study protocol is accessible at www.tentaclestudy.com. Results Overall 90-day mortality rate was 11.6%. Leakage characteristics with the largest prognostic effect on mortality were gastric conduit ischemia/necrosis (AOR 2.23, 95%CI 1.43-3.49), defect circumference ≥ 25% (AOR 2.10, 95%CI 1.32-3.36) and intrathoracic fluid collections (drained AOR 1.98, 95%CI 1.05-3.75; undrained AOR 2.43, 95%CI 1.57-3.75). Patient parameters with the largest prognostic effect were ASA-score ≥ 3 (AOR 4.18, 95%CI 1.67-10.51), ECOG-score ≥ 2 (AOR 2.83, 95%CI 1.56-5.14) and respiratory failure (AOR 3.89, 95%CI 2.67-5.66), hemodynamic failure (AOR 3.09, 95%CI 1.96-4.88) or renal failure (AOR 4.08, 95%CI 2.20-7.59) at time of AL diagnosis. Conclusion Defect circumference, intrathoracic fluid collections, gastric conduit condition and several patient parameters were identified as prognostic factors for mortality in patients with AL. Adjusting for these prognostic factors may reduce confounding bias in future studies assessing efficacy of AL treatments. The identified prognostic factors contribute to the understanding of the severity of anastomotic leakage after esophagectomy and may be used to recognize the severity of an anastomotic leak in individual patients.

Characteristics and mortality in primary Sjögren syndrome-related interstitial lung disease.

Aim of the study was to determine the characteristics and prognosis, and to identify the risk factors for mortality in patients with primary Sjögren syndrome (pSS) with interstitial lung disease (pSS-ILD).A total of 1422 patients with SS were screened and 178 patients with pSS-ILD were recruited. The medical records and outcomes were retrospectively reviewed. Overall survival and case control study were performed to explore the predictors of death.Among 178 pSS-ILD patients, 87.1% were women. Mean age was 61.59 ± 11.69-year-old. Median disease duration was 72.0 (24.0, 156.0) months. Nonspecific interstitial pneumonia was the predominant high-resolution computed tomography pattern (44.9%). Impairment in diffusion capacity was the most common abnormality of pulmonary function test (75.8%) and the most severe consequence. Type 1 respiratory failure and hypoxia were observed in 15.0% and 30.0% patients, respectively. Mean survival time after confirmation of pSS-ILD diagnosis was 9.0 (6.8, 13.0) years. The 10-year survival rate for all patients with pSS-ILD was 81.7%. Forty-four (24.7%) of 178 patients died during the follow-up period. The most predominant cause of death was respiratory failure (n = 27). Twenty-seven patients died of ILD and formed study group. The 78 patients who survived formed control group. Age and smoking were risk factors for mortality in patients with pSS-ILD. In addition, severity of ILD, as reflected by high-resolution computed tomography, pulmonary function test, and arterial blood gas, was an independent risk factor. However, inflammation status (erythrocyte sedimentation rate, C-reactive protein) and anti-Sjögren syndrome–related antigen A and anti-Sjögren syndrome–related antigen B were not.ILD is a severe complication of pSS. Age, smoking, and severity of lung involvement are more critical for prognosis rather than inflammation status and autoantibodies.

Sex as a prognostic factor for mortality in critically ill adults with sepsis: a systematic review and meta-analysis

ObjectiveTo assess the role of sex as an independent prognostic factor for mortality in patients with sepsis admitted to intensive care units (ICUs).DesignSystematic review and meta-analysis.Data sourcesMEDLINE, Embase, Web of...