Subgroup Of High-risk Patients Research Articles

Laryngeal involvement in relapsing polychondritis: clinical and CT findings in 173 patients.

Relapsing polychondritis (RP) is a rare autoimmune disorder primarily affecting cartilaginous structures. We aimed to characterise the clinical features and CT findings of laryngeal involvement in RP, hypothesising that specific CT patterns correlate with clinical manifestations. We retrospectively analysed 173 patients with confirmed RP. Demographic and clinical data were collected, and laryngeal, tracheal, and bronchial CT findings were reviewed. Statistical analyses identified factors associated with laryngeal involvement and airway stenosis. Notably, 66% of asymptomatic patients displayed CT evidence of airway damage, with laryngeal involvement in 41.1% (44/107), tracheal involvement in 80.9% (140/173), and bronchial involvement in 36.4% (63/107). Cricoid erosion and broadening with mucosal hyperplasia were the predominant laryngeal findings. Significant associations with laryngeal involvement included younger age at disease onset (p<0.05), longer disease duration (p<0.01) and multiorgan manifestations (p<0.01). Laryngeal involvement is common in RP patients with airway manifestations, second only to tracheal involvement. CT findings of cricoid erosion and broadening are characteristic. Vigilant clinical monitoring is recommended for RP patients with identified risk factors to facilitate early detection and management. Future research should focus on developing targeted interventions for this high-risk subgroup of RP patients.

Impact of Heel Ulcers on Patients Admitted for Diabetic Foot Disease.

The current study aimed to evaluate the clinical outcomes of patients admitted for diabetic foot ulcers (DFUs) located in the heel. The study is a retrospective observational study including a population of patients admitted for DFUs from April 2024 to September 2024. According to the wound location, patients were divided in two groups: those with heel ulcers and those with forefoot/midfoot ulcers without calcaneal involvement. All patients have been managed through a limb salvage protocol in the respect of international guidelines. The following hospital outcomes were evaluated: minor and major amputation, mortality, length of stay, need for regenerative surgery by using dermal-epidermal graft. Overall, 150 patients were included. The mean age was 70.2 ± 12.2 years, most patients were male (76.0%), had type 2 diabetes (92.7%) with a mean duration of 22.1±13.2 years; 27 (18%) patients had heel ulcers, while 123 (82%) had forefoot/midfoot lesions. Outcomes for patients with heel location and without were: minor amputation (18.5 vs 32.5%, p = 0.1), major amputation (7.4 vs 0.8%, p = 0.02), mortality (0 vs 0.8%, p = 0.5), length of hospital stay (17.5 ± 8.5 vs 14.4 ± 8.7 days, p = 0.08), need for regenerative therapy using dermal-epidermal substitutes (48.1 vs 19.5%, p = 0.003) respectively. In addition, heel ulcer was found to be an independent predictor for major amputation [OR 5.06, CI95% (3.1-11.4), p = 0.02] and length of stay [OR 6 CI95% (3.6-10.9), p = 0.003]. In patients admitted for DFUs, wounds located in the heel were associated to an increased risk of major amputation, need for regenerative therapy and length of stay (even though in the limit of statistical difference) than wounds not located in the heel. These data underline the need for tailored management strategies in this high-risk subgroup of patients.

S-adenosylmethionine addiction confers sensitivity to methionine restriction in KMT2A-rearranged acute lymphoblastic leukemia.

Current intensive chemotherapy regimens have improved overall survival in pediatric acute lymphoblastic leukemia (ALL) but fail to cure some high-risk patient subgroups. We observed that lysine methyltransferase 2A (KMT2A)-rearranged leukemia, an aggressive subset with a dismal prognosis, is particularly vulnerable to perturbations of the methionine cycle. We demonstrate that this methionine dependency is driven by an increased need for S-adenosylmethionine (SAM) to maintain the hypermethylated state of KMT2A-r leukemias. Important pro-survival KMT2A-r target genes are repressed under methionine restriction, which, combined with other downstream metabolic changes, results in rapid cell death. FIDAS-5, an orally active methionine adenosyltransferase 2A (MAT2A) inhibitor that blocks SAM production, successfully impaired leukemia progression in patient-derived xenograft models, and a drug screen revealed strong synergy between MAT2A inhibition and histone deacetylase inhibitors. Our results identify the methionine cycle as a targetable vulnerability in KMT2A-r leukemia, which may increase the efficacy of epigenetic targeting agents.

Lactate Levels and Their Relation to Surgical Site Infections in Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy.

Introduction: Peritoneal carcinomatosis (PC) patients undergoing cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) face a high risk of morbidity. Surgical site infections (SSIs) are among the main contributors to this issue. This relation is influenced not only by the effects of major surgical resections but also by the hemodynamic changes induced by HIPEC. Although elevated lactate levels (LL) have been associated with greater complication rates in CRS-HIPEC patients, their direct association with the development of SSIs has not been thoroughly investigated. Methods: Patients who underwent CRS + HIPEC were retrospectively reviewed. Pre-operative demographic data, hemodynamic parameters and records, transfusion records, and all post-operative follow-up and treatment records were analyzed. Patients were categorized into SSI+ and SSI-. Factors contributing to SSI development were examined using regression analysis. Results: A total of 110 patients who underwent CRS + HIPEC between January 2018 and December 2021 were included in the study. LL obtained at intensive care unit (ICU) admission were greater in patients who developed SSIs (p = 0.020). Cutoff point for ICU admission LL in diagnosing SSI was ≥6 mmol/L (area under the curve: 0.640 [0.526-0.753], p = 0.020). SSI development (23% vs. 50%, p = 0.003) was more prevalent in patients with lactate values ≥6 mmol/L. In multi-variable analysis, LL ≥6 mmol/L (odds ratio [OR]: 4.614, p = 0.005) and clean-contaminated wounds (OR: 27.677, p = 0.002) were related with increased SSI development. Conclusion: In patients with PC, LL of 6 mmol/L or greater during the ICU stay have been associated with SSI development. For this high-risk patient subgroup, a readily available peri-operative parameter such as lactate may guide prophylactic antibiotic selection. However, despite its high specificity, the low sensitivity of our findings should be carefully considered before clinical decision-making. Further studies analyzing larger, more homogeneous cohorts are needed to better clarify the relation between LL, SSI development, and prophylactic antibiotic use.

Adjuvant hyperthermic intraperitoneal chemotherapy in patients with colon cancer at high risk of peritoneal metastases: individual patient data meta-analysis.

About a quarter of patients with locally advanced colon cancer (pT4) develop locoregional recurrence, including peritoneal metastases. The aim of this individual patient data meta-analysis (IPDMA) was to evaluate the efficacy of adjuvant hyperthermic intraperitoneal chemotherapy (HIPEC) with regard to reducing the locoregional recurrence rate in the overall population and high-risk subgroups of patients with locally advanced colon cancer. A systematic literature search was conducted in July 2024 to identify RCTs on adjuvant HIPEC in addition to routine adjuvant systemic chemotherapy in locally advanced colon carcinoma. An IPDMA was performed, with the locoregional recurrence rate as the primary endpoint and disease-free survival (DFS) and overall survival (OS) as secondary endpoints. The search identified two trials (COLOPEC and HIPECT4). Individual patient data were pooled for 386 patients, of whom 189 patients received adjuvant HIPEC and 197 patients constituted the control group. The median follow-up was 36 (interquartile range 32-60) months. A modified intention-to-treat analysis showed a 36-month locoregional recurrence rate of 16.0% for HIPEC patients and 21.2% for control patients (P = 0.295). Predefined subgroup analyses revealed a significant reduction in locoregional recurrence after HIPEC in patients with right-sided tumours (HR 0.56 (95% c.i. 0.48 to 0.67)) (P < 0.001). No significant differences in survival were found for the overall study population; low event rates in subgroups did not allow for survival analyses. Adjuvant HIPEC significantly reduced the locoregional recurrence rate in right-sided locally advanced colon cancer, but not in the overall study population. Definitive conclusions on DFS and OS require longer follow-up.

Dynamic ctDNA tracking stratifies relapse risk for triple negative breast cancer patients receiving neoadjuvant chemotherapy

Early Triple negative breast cancer (eTNBC) is the subtype with the worst outcome. Circulating tumor DNA (ctDNA) is shown to predict the prognosis of breast cancer, but its utility in eTNBC remains unclear. 130 stage II-III female eTNBC patients receiving neoadjuvant chemotherapy (NAC) have been enrolled prospectively and subjected to ctDNA analysis. ctDNA at post-NAC (pre-surgery) and post-surgery, but not at baseline, is associated with worse prognosis. A threshold of 1.1% maximum variant allele frequency at baseline stratifies patients with different relapse risk, which is validated internally and externally. A systemic tumor burden model integrating baseline and post-surgery ctDNA is independently prognostic (p = 0.022). Combining systemic tumor burden with pathologic response identifies a highly curable subgroup and a subgroup of high-risk eTNBC patients. ctDNA surveillance during follow-up identifies patients with high relapse risk. In conclusion, systemic ctDNA analysis demonstrates the utility of a systemic tumor burden model of ctDNA in risk stratification of eTNBC patients, which may guide future treatment escalation or de-escalation trials.

Future Directions of Chronic Total Occlusion Management: Identifying the Right Patient for Intervention With a Focus on Biomarkers.

The management of a chronic total occlusion (CTO) of a coronary artery has been a conundrum in interventional cardiology, as revascularization has not been proven to provide a mortality benefit. However, there are subgroups of patients with a CTO that have high levels of ischemia on myocardial perfusion imaging and high circulating levels of high sensitivity troponin-I (hsTn-I) and N terminal pro-brain natriuretic peptide (NT pro-BNP) that are at a particularly high-risk for adverse cardiovascular events. These high-risk subgroups of patients with a CTO may have not been well represented in prior clinical trials, and may gain a mortality benefit from revascularization of the CTO. Conversely, patients with low levels of ischemia and these biomarkers are at lower risk and may not gain a mortality benefit from revascularization of their CTO. It is important for future randomized controlled trials to investigate the efficacy of CTO PCI in patients with elevated biomarkers and high ischemic burden on myocardial perfusion imaging to determine if patients at high-risk gain a mortality benefit from revascularization.

Genomic characterization of the HER2-enriched intrinsic molecular subtype in primary ER-positive HER2-negative breast cancer

ER-positive/HER2-negative (ERpHER2n) breast cancer classified as PAM50 HER2-enriched (ERpHER2n-HER2E) represents a small high-risk patient subgroup. In this study, we investigate genomic, transcriptomic, and clinical features of ERpHER2n-HER2E breast tumors using two primary ERpHER2n cohorts comprising a total of 5640 patients. We show that ERpHER2n-HER2E tumors exhibit aggressive clinical features and poorer clinical outcomes compared to Luminal A and Luminal B tumors. Furthermore, ERpHER2n-HER2E breast cancer does not consist of misclassified or HER2-low cases, has little impact of ERBB2, is highly proliferative and less ER dependent than other luminal subtypes. It is not an obvious biological entity but is nevertheless associated with potentially targetable molecular features, notably a high immune response and high FGFR4 expression. Strikingly, molecular features that define the HER2E subtype in luminal disease are also consistent in HER2-positive disease, including an epigenetic mechanism for high FGFR4 expression in breast cancer.

α-Fetoprotein model versus Milan criteria in predicting outcomes after hepatic resection for hepatocellular carcinoma: multicentre study.

The Milan criteria and the French α-fetoprotein (AFP) model have both been validated for predicting outcomes after liver transplantation for hepatocellular carcinoma, with the Milan criteria also used for predicting outcomes after hepatic resection. The aim of this study was to evaluate the AFP model's predictive value for recurrence and survival following hepatocellular carcinoma resection and compare its performance with that of the Milan criteria. Data for patients who underwent hepatocellular carcinoma resection between 2002 and 2021 were analysed. For both the AFP model and Milan criteria, patients were divided into two groups: those with hepatocellular carcinoma within and beyond the AFP model (scores ≤ 2 and > 2 points, respectively) and the Milan criteria. Cumulative recurrence and overall survival rates were compared between patients within and beyond the AFP model. Predictions of recurrence and overall survival by the AFP model and Milan criteria were compared using net reclassification improvement and area under the receiver operating characteristic curve analyses. Among 1968 patients evaluated, 1058 (53.8%) and 940 (47.8%) were classified as beyond on the AFP model and Milan criteria, respectively. After controlling for competing factors on multivariable analyses, being beyond the AFP model was independently associated with recurrence and worse overall survival after resection of hepatocellular carcinoma. Time-dependent net reclassification improvement and area under the receiver operating characteristic curve analyses demonstrated that the AFP model was superior to the Milan criteria in predicting recurrence. Of note, patients who were classified as beyond both the Milan criteria and AFP model had an even higher risk of postoperative recurrence and mortality (hazard ratios 1.51 and 1.47, respectively). The French AFP model demonstrated superior prognostic accuracy to the Milan criteria in predicting recurrence and survival after hepatocellular carcinoma resection. The AFP model not only effectively stratified patient risk but also identified a subgroup of high-risk patients among those beyond the Milan criteria.

Outcomes and Management of Positive Margins in Chondrosarcoma With Soft Tissue Extension: A Case Series and Review of Literature.

Chondrosarcoma accounts for 20% of all bone sarcomas and may present with soft tissue extension. The presence of an extraosseous component, along with positive surgical margins, independently have been associated with increased risk of local recurrence and decreased survival. The purpose of this investigation is to describe the treatment and outcomes of six chondrosarcoma patients who presented with chondrosarcoma with soft tissue extension along with positive surgical margins post negative en bloc resection. This was a retrospective review over a consecutive 13-year period. Data including treatment details and outcomes were included. All patients underwent attempted negative margin en bloc resection and encountered unplanned positive margins on intraoperative determination or postoperative pathology (R1). A total of six cases were identified. Average age (SD) was 61.8 years (6.11) with median (IQR) follow-up of 17.0 months (10.3-39.5). Three (50.0%) cases arose in the extremities, and 3 (50.0%) cases in the pelvis. All patients underwent attempted negative margin en bloc resection. Three (50.0%) cases recurred with median (IQR) time to recurrence of 10.0 months (9.0-31.0). At study conclusion, 5 (83.3%) were alive with median (IQR) survival of 20.5 months (11.3-41.0). Despite limited sample size, our data reflected a significantly higher recurrence rate compared to either chondrosarcomas with positive margins or extraosseous extension. Our cohort represents a high-risk subgroup of chondrosarcoma patients, which may dictate increased monitoring and guide future treatment recommendations for these patients.

Effects of Pancreatitis and Type 2 Diabetes Mellitus on the Development of Pancreatic Cancer: A Nationwide Nested Case-Control Study.

Despite diabetes mellitus (DM) and pancreatitis being known risk factors for pancreatic cancer, patients with these conditions are not included in pancreatic cancer screening due to the low incidence of pancreatic cancer in these populations. This study aimed to determine the high-risk subgroup of patients with diabetes and pancreatitis that would benefit from pancreatic cancer screening. A nested case-control study was conducted using data from the National Health Information Database of the Korean National Health Insurance Service. Patients were categorized into the following groups: type 2 diabetes mellitus only (T2DM-only), pancreatitis-only (PAN-only), T2DM followed by pancreatitis (T2DM-PAN), post-pancreatitis diabetes mellitus (PPDM), and no diabetes and no pancreatitis (NDNP). Conditional logistic regression was used to determine significant associations of each group with pancreatic cancer development risk. The risk of pancreatic cancer was significantly higher in the T2DM-PAN (adjusted odds ratio [AOR], 4.96; 95% confidence interval [CI], 4.48 to 5.49) and PPDM (AOR, 4.71; 95% CI, 4.12 to 5.37) groups than in the NDNP group. Compared to patients in the NDNP group, those with PPDM using insulin had a 17-fold increased risk (AOR, 16.72; 95% CI, 9.50 to 29.43), and individuals with PPDM who had diabetes for less than 3 years had a more than 8-fold increased risk of pancreatic cancer (AOR, 8.83; 95% CI, 5.99 to 13.01). In patients with post-pancreatitis diabetes, insulin use or shorter duration of diabetes was associated with a higher risk of pancreatic cancer, suggesting that patients in these subgroups may require close monitoring for pancreatic cancer development.

Is Frailty Associated with Worse Outcomes After Major Liver Surgery? An Observational Case-Control Study.

Background: The rate of morbidity after liver surgery is estimated at 30% and can be even higher when considering higher-risk subgroups of patients. Frailty is believed to better predict surgical outcomes by showcasing the patient's ability to withstand major surgical stress and selecting frail ones. Methods: This is a single-centre, observational case-control study on patients diagnosed with liver malignancies who underwent liver resections between 2013 and 2024. The five-item modified Frailty Index (mFI-5) was used to split patients into frail and non-frail. The two groups were compared in terms of preoperative, operative and postoperative outcomes using a chi-squared and logistic regression model. Results: A total of 230 patients were included and split into two groups: non-frail, NF, n = 90, and frail patients, F, n = 140. Overall, F patients had a higher rate of morbidity (p = 0.04) but with similar mortality and length of stay. When considering only major liver resections, F patients had a higher probability of posthepatectomy liver failure (LR 6.793, p = 0.009), postoperative bleeding (LR 9.541, p = 0.002) and longer ICU stay (LR 8.666, p = 0.003), with similar rates of bile leak, surgical site infections, length of stay and mortality. Conclusions: Frailty seems to be a solid predictor of posthepatectomy liver failure in patients undergoing major liver resections and is associated with a longer ICU stay. However, mortality and surgical morbidity seem to be comparable between frail and non-frail patients.

Safety and Feasibility of Early Extubation in Liver Transplantation: Experience in 1555 Patients.

Early extubation after liver transplantation can decrease cost and intensive care unit lengths of stay, but its adoption remains limited because of safety concerns. We assessed the feasibility and safety of early extubation at a liver transplant center with a high early extubation rate. We analyzed subgroups of high-risk patients, including high model for end-stage liver disease-sodium (MELD-Na) score, high intraoperative blood loss, and patients undergoing simultaneous liver-kidney transplantation. We included all adult liver transplantations performed at a single center between June 2012 and July 2022. Patients were divided into 2 groups: (1) those extubated early (ie, in the operating room or within the first hour of intensive care unit admission) and (2) those who underwent delayed extubation. The primary outcome was reintubation within 48 h after early extubation. Rates of early extubation were analyzed separately for quartiles of MELD-Na score and intraoperative blood loss. Of 1555 patients, 969 (62%) were extubated early. Of these, 31 patients (3.2%) required mechanical ventilation within 48 h postoperatively: 11 patients (1.1%) were reintubated for respiratory failure and 20 (2.1%) remained intubated after reoperation. There was no difference in postoperative pneumonia between the groups (P = 0.059). Early extubation rates inversely correlated with the quartiles of MELD-Na score and estimated blood loss. In the highest quartile for MELD-Na (>34) and estimated blood loss (>5 L), 34% of patients were extubated early. Early extubation of properly selected patients after liver transplantation is safe and associated with a low rate of reintubation, even among select groups of high-risk patients.

Real-World Effectiveness of Sotrovimab in Patients Infected With SARS-CoV-2 Omicron Subvariant BA.2 in Western Sydney, Australia.

Laboratory-based findings suggest that Sotrovimab is significantly less effective against emerging CARS-CoV-2 variants, however, clinical data is lacking. Here we examined the effectiveness of sotrovimab, in preventing emergency department (ED) presentation and subsequent hospitalization in high-risk subgroups of patients during the SARS-CoV-2 Delta and Omicron waves in Western Sydney, Australia (n = 515). Risk for ED attendance was comparable in Omicron patients, whether BA.1 or BA.2, compared to Delta patients (hazard ratio of 0.97 [0.36-2.64]). These findings highlight the need for caution when using in vitro findings to drive clinical practice, especially when the consequence is to withhold potentially lifesaving treatment.

The potential for Safewards to reduce restrictive interventions for people arriving to the emergency Department with police for a mental health assessment.

A retrospective file audit was conducted using pre and post measures on the use of restrictive interventions following the implementation of Safewards. Demographic and restrictive interventions data were extracted from the hospital databases 12 months before and 6 months after Safewards was implemented. All patients transported to the ED by police for a mental health assessment were included in two regional emergency departments in Victoria, Australia, with over 122,000 presentations per year accredited by the Australasian College for Emergency Medicine. There were 1379 pre and 543 post attendances accompanied by police. Of these, 85.5% pre and 99.1% post were transported to the hospital under Section 351 of the MHA (2014). Post implementation, there were fewer code grey events (clinical and security responses to unarmed threat) that required restrictive interventions including mechanical or chemical restraint. The number of code grey events in which no restrictive intervention was applied increased from 76.7% to 86.6%. Staff assigned higher triage ratings following the introduction of Safewards. There was a significant reduction in code grey events that used one restrictive intervention after implementing Safewards ED interventions (15.6% versus 7.2%; p=<0.001). Significantly fewer sedative medications were administered to manage behaviour on arrival (20.6% pre versus 9.8% post, p=<0.001). The Safewards ED adaptation may have contributed to a reduction in the use of restrictive interventions in this high-risk subgroup of patients frequently subject to restrictive interventions in the ED. Further research is required to validate the findings from this subgroup analysis.

Raphe-Type Bicuspid Aortic Valve as a Risk Factor for Transcatheter Aortic Valve Replacement Failure: Improving Outcomes Using the LIRA Method and the Medtronic FX Prosthesis.

Transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis and raphe-type bicuspid aortic valve (BAV) is still associated with poor outcomes in terms of increased risk of paravalvular regurgitation, stroke, and permanent pacemaker implantation. There is no definitive consensus on the optimal sizing method for prosthesis selection in this setting. The LIRA method is a supra-annular tailored sizing method specifically designed for bicuspid anatomy that might increase accuracy of prosthesis choice in BAV patients and improve TAVR outcomes. This is the first report of the combination of the novel LIRA method for prosthesis sizing together with the adoption of the technological improvements introduced by the Evolut FX prosthesis as a useful tool for improving outcomes in this high risk subgroup of patients.

Multilevel Analysis of MYC and BCL2 Aberrations in Diffuse Large B-Cell Lymphoma: Identifying a High-Risk Patient Subgroup Across Cell-of-Origin Using Targeted Sequencing.

Diffuse large B-cell lymphoma (DLBCL) exhibits striking clinical and biological heterogeneity. Recent studies have identified new subgroups within germinal center B-cell like (GCB) DLBCL, associated with inferior prognosis, irrespective of MYC and BCL2 translocations. We explored the existence of such a DLBCL high-risk subgroup, based on multilevel aberrations, especially focusing on MYC and BCL2. Tissue samples from 111 DLBCL patients were sequenced with a 90-gene lymphoma panel, followed by integrative analyses combining sequencing data, immunohistochemistry, fluorescent insitu hybridization, and clinical data. We identified a high-risk subgroup in DLBCL defined by: dual immunohistochemical MYC and BCL2 expression (DEL), concurrent MYC and BCL2 translocations (DHL-BCL2), mutations in MYC, CXCR4, or both, and/or BCL2 amplification. The high-risk subgroup constituted 41% of the cohort and included DHL-BCL2, DEL, a GCB subgroup likely representing the recently described GCB subgroups, and a subset of non-GCB patients. In multivariate analysis, high-risk features provided independent predictive value from age and IPI. The 5-year overall survival was 36% in high-risk patients, compared to 76% in non-high-risk patients. We identified a distinct high-risk DLBCL subgroup, characterized by MYC and BCL2 aberrations, beyond conventional DHL-BCL2 and DEL, and irrespective of cell-of-origin, thereby expanding the poor-prognosis group.

Abstract 4147668: Impact of New Onset Atrial Fibrillation on In-Hospital Mortality and Other Outcomes Among Patients Admitted for STEMI: A 5-Year Analysis from the National Inpatient Sample

Introduction: New onset atrial fibrillation (NOAF) is not a so rare condition among patients hospitalized for ST-segment elevation myocardial infarction (STEMI). However, it’s short-term prognostic value have not yet been studied using a large real-world data. Aim: To evaluate in-hospital mortality and other clinical outcomes of this high-risk subgroup of patients using a large US real-world data. Methods: Between January 2017 and December 2021, 855,400 STEMI patients were identified from the NIS database using ICD-10 codes. The cohort was divided into two groups: those with NOAF and those without (non-NOAF). Outcomes studied included in-hospital mortality and complications such as cardiac arrest, cardiogenic shock requiring pressors or mechanical circulatory support (MCS), acute stroke, and gastrointestinal bleed. Categorical variables were presented as percentages, and continuous variables as median ± interquartile range. Outcomes were analyzed using univariate and multivariate logistic regression to adjust for potential confounders. Results: Of the 855,400 STEMI patients, 51,845 (6%) developed new-onset atrial fibrillation (NOAF) during hospitalization. NOAF patients were generally older (70 vs. 63 years), more likely to be women (32.9% vs. 30%), and more often Caucasian. They also had higher rates of COPD (24.6% vs. 12.3%) and valvular diseases (13.8% vs. 8.2%) compared to non-NOAF patients. Univariate analysis showed NOAF was linked to worse outcomes. Multivariate logistic regression, adjusting for age, gender, race, insurance type and comorbidities, revealed NOAF patients had twice the risk of in-hospital mortality (OR: 2.08, CI: 1.96-2.21, P&lt;0.001) and higher odds of complications: cardiac arrest (OR: 1.9, CI: 1.8-2.19, P&lt;0.001), cardiogenic shock requiring MCS (OR: 2.15, CI: 1.94-2.39, P&lt;0.001), stroke (OR: 1.36, CI: 1.19-1.56, P&lt;0.001), and gastrointestinal bleed (OR: 1.56, CI: 1.4-1.74, P&lt;0.001). Conclusions: In this retrospective study, developing NOAF during index hospitalization for STEMI was associated with higher risk of in-hospital mortality and developing serious complications. Therefore, clinicians should recognize as a sign of worse prognosis and treat NOAF as soon as possible.

Results of the Regimen Dime in Diffuse Large B-Cell Lymphoma with MYC over-Expression: A Retrospective Analysis

Results of the Regimen Dime in Diffuse Large B-Cell Lymphoma with MYC over-Expression: A Retrospective Analysis

In-hospital bioimpedance-derived total body water predicts short-term cardiovascular mortality and re-hospitalizations in acute decompensated heart failure patients.

Hospital re-admissions in heart failure (HF) patients are mostly caused by an acute exacerbation of their chronic congestion. Bioimpedance analysis (BIA) has emerged as a promising non-invasive method to assess the volume status in HF. However, its correlation with clinically assessed volume status and its prognostic value in the acute intra-hospital setting remains uncertain. In this single-center observational study, patients (n = 49) admitted to the cardiology ward for acute decompensated HF (ADHF) underwent a daily BIA-derived volume status assessment. Median hospital stay was 7 (4-10) days. Twenty patients (40%) reached the composite endpoint of cardiovascular mortality or re-hospitalization for HF over 6months. Patients at discharge displayed improved NYHA class, lower body weight, plasma and blood volume, as well as lower NT-proBNP levels compared to the admission. Compared to patients with total body water (TBW) less than or equal to that predicted by body weight, those with higher relative TBW levels had elevated NT-proBNP and E/e´ (both p < 0.05) at discharge. In the Cox multivariate regression analysis, the BIA-derived delta TBW between admission and discharge showed a 23% risk reduction for each unit increase (HR = 0.776; CI 0.67-0.89; p = 0.0006). In line with this finding, TBW at admission had the highest prediction importance of the combined endpoint for a subgroup of high-risk HF patients (n = 35) in a neural network analysis. In ADHF patients, BIA-derived TBW is associated with the increased risk of HF hospitalization or cardiovascular death over 6months. The role of BIA for prognostic stratification merits further investigation.