Higher Odds Of Mortality Research Articles

Population Risk Factors for Severe Disease and Mortality in COVID-19 in the United States during the Pre-Vaccine Era: A Retrospective Cohort Study of National Inpatient Sample

Background-Previous studies on coronavirus disease 2019 (COVID-19) were limited to specific geographical locations and small sample sizes. Therefore, we used the National Inpatient Sample (NIS) 2020 database to determine the risk factors for severe outcomes and mortality in COVID-19. Methods-We included adult patients with COVID-19. Univariate and multivariate logistic regression was performed to determine the predictors of severe outcomes and mortality in COVID-19. Results-1,608,980 (95% CI 1,570,803-1,647,156) hospitalizations with COVID-19 were included. Severe complications occurred in 78.3% of COVID-19 acute respiratory distress syndrome (ARDS) and 25% of COVID-19 pneumonia patients. The mortality rate for COVID-19 ARDS was 54% and for COVID-19 pneumonia was 16.6%. On multivariate analysis, age > 65 years, male sex, government insurance or no insurance, residence in low-income areas, non-white races, stroke, chronic kidney disease, heart failure, malnutrition, primary immunodeficiency, long-term steroid/immunomodulatory use, complicated diabetes mellitus, and liver disease were associated with COVID-19 related complications and mortality. Cardiac arrest, septic shock, and intubation had the highest odds of mortality. Conclusions-Socioeconomic disparities and medical comorbidities were significant determinants of mortality in the US in the pre-vaccine era. Therefore, aggressive vaccination of high-risk patients and healthcare policies to address socioeconomic disparities are necessary to reduce death rates in future pandemics.

Regional differences of tracheostomy in extremely premature neonates across the United States.

To identify regional differences in tracheostomy rates and mortality in extremely premature neonates. The 1997-2019 Kids' Inpatient Databases (KID) were queried to identify children who completed 27 weeks gestation (27-wk) or less and 23 weeks gestation (23-wk) or less. Multivariable logistic regressions compared odds of tracheostomy and mortality by region (Midwest (MW), Northeast (NE), South (S), and West (W)) while controlling for demographic variables and comorbidities. Trend analyses were performed using Poisson Regressions. There were 2433 27-wk or less infants and 259 23-wk or less who received a tracheostomy. The MW was the only region where higher odds of tracheostomy were seen for 27-wk or less (aOR 1.25 [95%CI 1.12-1.39]) and 23-wk or less (aOR 1.68 [95%CI 1.24-2.27]) neonates when compared to all other regions combined. The S and MW had the highest increase in tracheostomy rates of 27-wk or less (β=5.1, r=0.77, p=0.025; β=3.8, r=0.93, p=0.001), and the MW had the highest increased rate of tracheostomy for 23-wk or less (β=1.9, r=0.97, p=0.008). There were no higher mortality odds by region in 27-wk or less. Mortality was the highest in the S for 23-wk or less (20.8%, p=0.015). This study identified regional differences in tracheostomy rates in extremely premature infants. Extremely premature neonates in the MW had higher odds of receiving a tracheostomy with comparable mortality rates to other regions. Further research is needed to analyze regional practice differences that may impact the decision to perform a tracheostomy.

Predictors of Hospitalizations and Death from COVID-19 in Patients with Multiple Myeloma

The COVID-19 (SARS-CoV-2) pandemic has led to unprecedented challenges in providing cancer care to patients all over the world. Compared to the general population, it is assumed that patients with hematologic malignancies are more susceptible to develop viral infections like COVID-19 and will experience more severe symptoms and complications given their immunocompromised status. METHODS This retrospective chart review included 57 patients who had multiple myeloma (MM), tested positive for COVID-19 and were hospitalized between 1/1/2020 until 5/1/2021. We report epidemiological, clinical, and laboratory characteristics along with outcomes. RESULTS 57 MM patients were included in the study. The mean age of our cohort was 70.54 years with a standard deviation of 11.65, and 57.89% (n=33) patients were male. 45.61% (n=26) were non-smokers, 22.81% (n=13) were currently smokers and 31.58% (n=18) were former smokers. While the odds of hospitalization were not significantly increased with age (OR 1.03 95% CI 0.98-1.09, p=0.163), the odds of death were slightly increased with age, and the results were statistically significant (OR 1.07 95%1.00 -1.14, p=0.03). Race, ethnicity, gender and BMI, smoking status and flu/pneumovax vaccination did not have any effect on the odds of neither hospitalization nor death. Between all comorbidities that were present in our cohort, none significantly affected the odds of hospitalization. However, patients with heart failure had higher odds of death (OR 4.11 95% CI 0.98-17.22, p=0.05), and those with asthma had lower odds of death (OR 0.08 95% CI 0.009-0.67, p=0.02). Between all multiple myeloma subtypes, no specific subtype affected the odds of death, and only the light chain disease significantly reduced the odds of hospitalization (OR 0.11 95% CI 0.02-0.72, p=0.021). No specific medication or treatment regimen influenced the odds of hospitalization or death. As for pretesting biochemical parameters, elevated blood urea nitrogen significantly increased the odds of hospitalization (OR 1.08 95% CI 1.01-1.16, p=0.023), while elevated bilirubin decreased those odds (OR 0.19 95% CI 0.05-0.79, p=0.022). On the other side, elevated pretesting procalcitonin increased the odds of death (OR 3.77 95% CI 1.09-13.07, p=0.036), unlike elevated albumin levels that lowered the odds of death (OR 0.41 95% CI 0.19-0.84, p=0.015). On admission, elevated LDH was the only parameter that significantly increased the odds of death (OR 1.01 95% CI 1-1.02, p=0.024). CONCLUSION In a predominantly unvaccinated cohort, several demographic factors and comorbidities increased the risk of hospitalization and mortality. Elevated LDH, BUN, procalcitonin were linked with higher odds of mortality, nature of myeloma therapy and presence of immunoparesis did not influence outcomes. More data is required to understand the effect of COVID-19 in vaccinated patients with multiple myeloma and other hematologic malignancies. Some limitations of this dual center institution study are the small sample size.

Abstract 15758: Association of Socioeconomic, Racial, and Regional Factors in In-Hospital Mortality Among Acute Myocardial Infarction Patients in the United States: A National Analysis of 2.8 Million Admissions

Background: Socioeconomic, racial, and regional disparities have been associated with worse clinical outcomes among patients with coronary disease. We evaluated the association of income, race, and geographic variation and in-hospital mortality among acute myocardial infarction (AMI) admissions in the United States. Methods: We conducted a retrospective cohort study using the Nationwide Inpatient Sample from 2015 to 2019. A multi-level logistic regression model was used (with sampling weights) to investigate the association between in-hospital mortality and income quartiles by patient’s ZIP code, race, and hospital regions, while adjusting for hospital clustering, lifestyle factors, clinical history, and hospital-level factors. Results: A total of 2,798,225 hospitalizations (≥18 years) with a principal diagnosis of AMI were identified. In multivariable analysis, compared with the highest income quartile, residents in the lowest income quartile (OR=1.10 [1.08–1.13] P <0.001) or second lowest income quartile (OR=1.07 [1.05–1.09] P <0.001) had higher odds of in-hospital mortality. Compared with those identifying as White, Black (OR=0.89 [0.87–0.91] P <0.001) and Hispanic (OR=0.91 [0.88–0.93] P <0.001) groups had lower odds of mortality, while Asian or Pacific Islander (OR=1.07 [1.03–1.11] P <0.001), Native American (OR=1.11 [1.02–1.21] P <0.05), and Unspecified groups (OR=1.09 [1.05–1.13] P <0.001) had higher odds of mortality. Residents in the South had higher mortality than those in the Northeast (OR=1.06 [1.00–1.12] P <0.05). Conclusion: Our large contemporary study shows that lowest income residents, Whites, Asian or Pacific Islanders, and Native Americans and residents of South had higher in-hospital mortality compared with highest income residents, Blacks and Hispanics, and residents in the Northeast. Additional studies are needed to better understand the complex mechanisms that underpin disparities in outcomes among AMI patients.

Abstract 15879: Impact of Pulmonary Hypertension on In-Hospital Outcomes for Patients Undergoing Typical Atrial Flutter Ablation

Introduction: Pulmonary hypertension (PHT) is a progressive disease with a clinical course characterized by frequent decompensations in advanced stages. Atrial arrhythmias, including typical atrial flutter, are common in patients with PHT. We sought to investigate the effect of presence of pulmonary hypertension to the outcomes after typical atrial flutter ablation. Methods: We utilized the National Inpatient database from 2016 to 2019 to perform this study. By utilizing the ICD-10-CM codes all hospitalizations for typical atrial flutter ablation were identified. Patients with atypical flutter and ablation were excluded. Among these subjects, those with associated diagnosis of pulmonary hypertension (WHO Group 1 to 5) were identified and they formed the study group. Primary outcome was to in-hospital mortality and complications. Secondary outcomes included analysis of patient clinical characteristics, length of hospital stay (LOS) and total hospital charges (TOTCH). Multivariate regression analysis was used to predict outcomes. Results: A total of 7,784 patients with PHT were hospitalized for typical atrial flutter ablation during the study period. Patients with PHT were slightly older (66 vs 67 years, p<0.001). The proportion of males was lower in the PHT group (57vs 67 %, p<0.001). For Typical AFL patients undergoing ablation, the presence of PHT was associated with higher odds of mortality (a0R= 1.8, p=0.003), acute kidney injury (a0R= 1.6, p<0.001), heart failure exacerbation (a0R= 1.3, p<0.001) and cardiogenic shock (a0R= 2.2, p<0.001) on multivariate regression analysis. They also had higher LOS (+2.3 days, p<0.001) and TOTCH (+$30,501, p<0.001). Conclusion: Our data shows that pulmonary hypertension is independently associated with worse in-hospital outcomes in patients undergoing typical atrial flutter ablation, including higher mortality. Further prospective studies are required to confirm our findings.

Abstract 262: Race/ethnicity Is Associated With Mortality After Pediatric Cardiopulmonary Resuscitation: An Analysis Of The KIDs’ Inpatient Database

Introduction: Survival disparities in adult in-hospital cardiac arrest (IHCA) are well-described with decreased survival in Black patients. Pediatric literature from AHA’s GWTG—Resuscitation did not show this association, possibly due to differences in IHCA definitions and patient population. We aimed to investigate associations between outcomes after pediatric CPR and race/ethnicity and insurance payer status in a nationally representative database. We hypothesized non-White race/ethnicity, compared to white race, and public insurance, compared to private insurance, would be associated with lower rates of survival. Methods: Retrospective cohort study of subjects ≤18 years with CPR procedure codes in the 1997- 2019 editions of the Healthcare Cost and Utilization Project Kids’ Inpatient Database (KID). We excluded subjects missing race/ethnicity, insurance payer or disposition and subjects with in-patient transfer as their disposition. We evaluated hypothesized associations with weighted mixed-effect logistic regression clustered by hospital. Hospital (size, teaching/non-teaching institution, rural/urban, region) and patient (age, KID cohort year, sex, insurance payer, complex chronic condition, median income quartile) confounders were considered fixed effects. Individual hospitals were treated as a random effect. Results: Our cohort included 27,332 children admitted to 3,353 centers. Univariable and multivariable modeling showed higher odds of in-hospital mortality for all non-White categories compared to white race: Black (aOR 1.20, 95% CI 1.08-1.34; p<0.001), Hispanic (aOR 1.17, 95%CI 1.05-1.31; p=0.006), and other race/ethnicity (aOR 1.37, 95%CI 1.20-1.57; p<0.001). There was no difference in mortality between those with public and private insurance. Conclusions: In contrast to previously published data, after risk- and reliability-adjustment of individual and hospital-level effects, children receiving CPR with non-White race/ethnicity had higher mortality odds. These findings suggest the presence of race/ethnicity-based disparities in pediatric IHCA mortality, the mechanisms of which should be explored.

Temperature Derangement on Admission is Associated With Mortality in Burn Patients-A Nationwide Analysis and Opportunity for Improvement.

Although single-institution studies have described the relationship between hypothermia, burn severity, and complications, there are no national estimates on how temperature on admission impacts hospital mortality. This study aims to evaluate the relationship between admission temperature and complications on a national scale to expose opportunities for improved outcomes. The US National Trauma Data Bank (NTDB) was analyzed between 2007 and 2018. Mortality was modeled using multivariable logistic regression including burn severity variables (% total burn surface area (TBSA), inhalation injury, emergency department (ED) temperature), demographics, and facility variables. Temperature was parsed into three categories: hypothermia (<36.0°C), euthermia (36.0-37.9°C), and hyperthermia (≥38.0°C). A total of 116,796 burn encounters were included of which 77.9% were euthermic, 20.6% were hypothermic and 1.45% were hyperthermic on admission. For every 1.0C drop in body temperature from 36.0°C, mortality increased by 5%. Both hypothermia and hyperthermia were independently associated with increased odds of mortality when controlling for age, gender, inhalation injury, number of comorbidities, and %TBSA burned (p < .001). All temperatures below 36.0°C were significantly associated with increased odds of mortality. Patients with ED temperatures between 32.5 and 33.5°C had the highest odds of mortality (22.0, 95% CI 15.6-31.0, p < .001). ED hypothermia and hyperthermia are independently associated with mortality even when controlling for known covariates associated with inpatient death. These findings underscore the importance of early warming interventions both at the prehospital stage and upon ED arrival. ED temperature could become a quality metric in benchmarking burn centers to improve mortality.

SHARP risk score: A predictor of poor outcomes in adults admitted for emergency general surgery: A prospective cohort study

PurposePost-operative complications following emergency abdominal surgery are associated with significant morbidity and mortality. Despite the knowledge of prognostic factors associated with poor surgical outcomes; few have described risks of poor outcomes based on admission information in acute surgical setting. We aimed to derive a simple, point-of-care risk scale that predicts adults with increased risk of poor outcomes. MethodsWe used data from an international multi-centre prospective cohort study. The effect of characteristics; age, hypoalbuminaemia, anaemia, renal insufficiency and polypharmacy on 90-day mortality was examined using fully adjusted multivariable models. For our secondary outcome we aimed to test whether these characteristics could be combined to predict poor outcomes in adults undergoing emergency general surgery. Subsequently, the impact of incremental increase in derived SHARP score on outcomes was assessed. ResultsThe cohort consisted of 419 adult patients between the ages of 16–94 years (median 52; IQR(39) consecutively admitted to five emergency general surgical units across the United Kingdom and one in Ghent, Belgium. In fully adjusted models the aforementioned characteristics; were associated with 90-day mortality. SHARP score was associated with higher odds of mortality in adults who underwent emergency general surgery, with a SHARP score of five also being associated with an increased length of hospital stay. ConclusionsSHARP risk score is a simple prognostic tool, using point-of-care information to predict poor outcomes in patients undergoing emergency general surgery. This information may be used to improve management plans and aid clinicians in delivering more person-centred care. Further validation studies are required to prove its utility.

Mortality and neurodevelopmental outcomes of infants with spontaneous intestinal perforation: a systematic review and meta-analysis

BackgroundThere is limited information about the mortality and neurodevelopmental outcomes of very preterm infants (<32 weeks) with spontaneous intestinal perforation (SIP).ObjectiveTo explore the association between SIP and neurodevelopmental outcomes and...

Comparisons of care practices for very preterm infants and their short-term outcomes in two tertiary centers in northwest and south China: A retrospective cohort study

BackgroundCare practices for very preterm infants and the mortality and morbidity of the infants vary widely among countries and regions with different levels of economic development, including the different areas in China. We aimed to compare the obstetric and delivery room practices of two representative tertiary newborn centers in the northwestern and southern regions of China and the mortality and morbidity of their very preterm infants.MethodsA retrospective cohort study was conducted. Very preterm infants born between 220/7 and 316/7 weeks of gestation, and admitted to Qinghai Red Cross Hospital (QHH) and Shenzhen Baoan Women’s and Children’s Hospital (SZH) from January 1, 2018 to December 31, 2020, were included. The infants’ characteristics and short-term outcomes, and the hospitals’ care practices were compared between the two cohorts.ResultsThree hundred and two infants in QHH and 505 infants in SZH were enrolled, and the QHH cohort was more mature than the SZH cohort was (gestational age 30.14 (29.14–31.14) vs. 29.86 (27.86–31.00 weeks, respectively), p < 0.001). Fewer antenatal steroids and more tracheal intubations were used in QHH than in SZH [(73.8% vs. 90.9%, p < 0.001) and (68.2% vs. 35.0%, p < 0.001, respectively)]. The odds of mortality [aOR = 10.31, 95%CI: (6.04, 17.61)], mortality or major morbidity [aOR = 5.95, 95%CI: (4.05, 8.74)], mortality despite active treatment [aOR = 3.14, 95%CI: (1.31, 7.53)], mortality or major morbidity despite active treatment [aOR = 3.35, 95%CI: (2.17, 5.17)], moderate or severe bronchopulmonary dysplasia [aOR = 3.66, 95%CI: (2.20, 6.06)], and severe retinopathy of prematurity [aOR = 3.24, 95%CI: (1.19, 8.83)] were higher in the QHH cohort. No significant difference in the rate of severe neurological injury or necrotizing enterocolitis ≥ Stage 2 was found between the cohorts.ConclusionObstetric and delivery room care practices used in the management of very preterm infants differed considerably between the QHH and SZH cohorts. Very preterm infants born in QHH have higher odds of mortality or severe morbidity compared with those born in SZH.

Hypoglycemia is associated with a higher risk of mortality and arrhythmias in ST-elevation myocardial infarction, irrespective of diabetes.

AimsWe aimed to assess the impact of hypoglycemia in ST-elevation myocardial infarction (STEMI).BackgroundHypoglycemia increases the risk of mortality in patients with diabetes and high cardiovascular risk.MethodsWe used the National Inpatient Sample (2005–2017) database to identify adult patients with STEMI as the primary diagnosis. The secondary diagnosis was hypoglycemia. We compared cardiovascular and socio-economic outcomes between STEMI patients with and without hypoglycemia and assessed temporal trends.ResultsHypoglycemia tends to complicate 0.17% of all cases hospitalized for STEMI. The mean age (±SD) of STEMI patients hospitalized with hypoglycemia decreased from 67 ± 15 in 2005 to 63 ± 12 in 2017 (p = 0.046). Mortality was stable with time, but the prevalence of ventricular tachycardia, ventricular fibrillation, acute renal failure, cardiogenic shock, total charges, and length of stay (LOS) increased with time (p < 0.05 for all). Compared to non-hypoglycemic patients, those who developed hypoglycemia were older and more likely to be black; only 6.7% had diabetes compared to 28.5% of STEMI patients (p = 0.001). Cardiovascular events were more likely to occur in hypoglycemia: mortality risk increased by almost 2.5-fold (adjusted OR = 2.625 [2.095–3.289]). There was a higher incidence of cardiogenic shock (adjusted OR = 1.718 [1.387–2.127]), atrial fibrillation (adjusted OR = 1.284 [1.025–1.607]), ventricular fibrillation (adjusted OR = 1.799 [1.406–2.301]), and acute renal failure (adjusted OR = 2.355 [1.902–2.917]). Patients who developed hypoglycemia were less likely to have PCI (OR = 0.596 [0.491–0.722]) but more likely to have CABG (OR = 1.792 [1.391–2.308]). They also had a longer in-hospital stay and higher charges/stay.ConclusionHypoglycemia is a rare event in patients hospitalized with STEMI. However, it was found to have higher odds of mortality, arrhythmias, and other comorbidities, irrespective of diabetes.

Inequalities in accessing quality healthcare, does insurance play a role? retrospective analysis of aortic emergencies from national inpatient sample 2019

Abstract Background Aortic emergencies, dissection and rupture, are rare but catastrophic entities, with the cornerstone to survival being prompt diagnosis and treatment. Insurance status often limits access to healthcare, and our study aims to determine if it plays a role in the outcomes of aortic emergencies. Method A retrospective analysis of the 2019 Nationwide Inpatient Sample was conducted to identify hospitalization (Age ≥18 &amp; non-elective) with aortic dissection and ruptured aortic aneurysms using ICD-10 codes. Discharge-level weight analysis was used to produce a national estimate. Variables were screened with univariate regression, and intermediate and co-linear variables were screened-out before a multivariable regression analysis model was built and performed to calculate the odds ratio. Results A total of 19,685 (0.06%) hospitalizations are identified for aortic emergencies (14965 dissections &amp; 4720 ruptured aneurysms). The mean age was 58.56, 62.7% were males, and ethnic distribution was 65.1% white, 19.5% blacks, 7.6% Hispanics, and others. 11.4% of the hospitalizations underwent diagnostic imaging with either CTA/MRA/TEE/Aortography within 24 hours. Hypotension/shock was present in 32% of these hospitalizations and was a risk factor for mortality OR 3.21 (p&amp;lt;0.00), increasing LOS by an average of 5.1 days and resource utilization by 156,000$. Another risk factor for mortality was stroke/TIA (OR-1.76, p&amp;lt;0.00), increasing LOS and resource utilization by 3.1 days and 80,662$, respectively. 3220 hospitalizations (16.4%) did not survive the course, and the mortality rate in uninsured, Medicare, and Medicaid was 17%, 20%,9% compared with 12% in privately insured. On crude analysis, uninsured and medicare patients appeared to have higher odds of mortality [OR 1.50, p&amp;lt;0.04, and OR 1.83 p-value &amp;lt;0.002 respectively], however upon adjusting for confounders, only uninsured patients showed statistically significant difference (OR 2.13, p&amp;lt;0.002). Similar results were corroborated on analyzing hospitalizations for aortic dissection; however, insurance status did not influence mortality in a ruptured aneurysm. When comparing hospitalization of median household income of ≥79,000$ with household of median income of 59,000–78,999 $, 46,000–58,999 $ and &amp;lt;46,000$ had higher odds of mortality (OR-1.38, p&amp;lt;0.04), (OR-1.44, p&amp;lt;0.02) and (OR-1.44, p&amp;lt;0.03) respectively. Of all the insurance types, a statistically significant difference compared with private insurance, Medicaid on average, had 2.8 more days and incurred an additional 62,912$ in resource utilization (p&amp;lt;0.00). Conclusion Inequalities in accessing healthcare, median household income, and insurance status are risk factors for mortality in aortic emergencies. Efforts are needed to bridge the gap in this particular facet of social determinants of health to find a sustainable and equitable solution for quality healthcare for aall regardless of their insurance status. Funding Acknowledgement Type of funding sources: None.

Association and outcomes of vf according to involved coronary artery in STEMI – a nationwide analysis

Abstract Background Ventricular fibrillation (VF) is common in acute ST segment elevation myocardial infarction (STEMI) and is associated with increased in-hospital mortality rate. Purpose We sought to investigate the association between VF and artery involved in STEMI Methods This is a retrospective observational study of hospitalizations between January 1, 2016 and December 31, 2019, using the National Inpatient Sample (NIS), the largest all-payer public database of hospital care in the United States. Results A total of 138,201 patients were primarily hospitalized for STEMI from 2016 to 2019. Among them 12,318 had right coronary artery (RCA) lesions, 427 had left main (LM) lesions, 2381 had left circumflex (LCx) lesions and 12,765 had left anterior descending (LAD) lesions. Mean age of patients with VF and STEMI was 62 years and that with RCA (63 years), LM (65 years), LCx (62 years), LAD (60 years), p&amp;lt;0.001. Females were 30.5% (n=42,231) among all STEMI group and 29.8% (n=3672) RCA, 29% (n=124) LM, 27.4%(n=653) LCx and 28.6%(n=3645) LAD, p&amp;lt;0.001. In-hospital mortality for all patients with STEMI was 7.9%. The in-hospital mortality associated with STEMI there was 5%, 23.4%, 6.6%, 7.1%, (p&amp;lt;0.001) for RCA, LM, LCx and LAD respectively. The incidence of VF among all patients with STEMI was 8.3% (n=11425) and for LM, LAD, LCX, and RCA was 12.9%, 10.7%, 9.2% and 7.9% (p&amp;lt;0.001). Mean hospital length of stay for VF with RCA (6.2 days), LM (5.5 days), LCx (6.9 days) and LAD (7.4 days). After adjusting for age, gender, race, income, comorbidities, hospital teaching status, region and year, patients with STEMI who had VF had higher odds of mortality (aOR 6.4, 95% CI, 6.1 to 6.8; P&amp;lt;0.001). The highest likelihood of mortality observed in patients with VF who had and LCx STEMI (aOR 7.9, CI 95%, 5 to 12.4; p&amp;lt;0.001) followed by RCA STEMI (aOR 7.4, 95% CI 6 to 9.1; p&amp;lt;0.001), and LM STEMI (aOR 6.1, 95% 3.1 to 12; p&amp;lt;0.001). Conclusion Highest in-hospital mortality was observed in patients with STEMI who had VF in LCx, followed by RCA and LM. There was higher occurrence of VF in STEMI involving LM. Funding Acknowledgement Type of funding sources: None.

Venous thromboembolism and mortality in a multiethnic population: a report from the Birmingham Black Country VTE registry (BBC-VTE Investigators)

Abstract Background Most epidemiological studies into venous thromboembolism (VTE) are based on the white Caucasian population and unrepresentative of VTE outcomes in non-white ethnicities. Purpose Our VTE registry aims to get an insight into the outcomes of VTE patients as applicable to a developed world population with a multi-ethnic background. This will guide clinicians to make appropriate decisions with regards to management and prognosis. Methods The Birmingham Black Country VTE Registry (BBC-VTE) is a multi-ethnic cohort of patients in the West Midlands region of the United Kingdom, who suffered a first episode of VTE. In this study we compared baseline characteristics, treatment patterns and outcomes, and secondly, compared these among the different ethnic groups in this region. Results Between the years 2012–2014 there was a total of 1615 patients (mean age 65.5; 53.1% female) admitted with a first episode of VTE of whom, 134 (8.3%) were Asian, 92 (5.7%) Black, and 1213 (75.1%) White. Asian patients were younger (mean age 54, SD 19.3) vs Black patients (59, SD 19.7) and White patients (68, SD 17.4); and were less often female (50.7% vs. 55.4% and 53.8%) for Black and White patients respectively. The initial VTE event was a DVT in 680 (42.1%) and a PE±DVT in 935 patients (57.9%). Below-knee and above-knee DVT occurred in 95 (5.9%) and 585 (36.2%) patients respectively. Recurrent DVT occurred in 3.2% of those with an initial below-knee DVT and 12.5% of those with an initial above-knee DVT. Recurrent PE was also more common in those with an initial above knee DVT (4.8%) compared to those with below-knee DVT (3.2%). After the initial VTE event, 1269 (78.6%) were started on long-term anticoagulation for the prevention of recurrent VTE. Of those, 65.1% stayed on anticoagulation for up to 6 months after the initial VTE event, and 34.9% continued for longer than 6 months, including those on lifelong anticoagulation. Bleeding and major bleeding occurred in 6.8% and 2.5% respectively in those on anticoagulation for 6 or less months, vs. 10.4% and 3.5% in those anticoagulated for longer than 6 months. The most common site of bleeding was gastrointestinal in 42.3% of all bleeds and this site was also responsible for 54.3% of major bleeds. From evaluating the odds ratio for VTE mortality (see Fig. 1), ethnicity did not have a significant impact. Older age; the presence of diabetes mellitus; history of malignancy; as well as admission laboratory results for C-reactive protein and neutrophil count were all significantly associated with higher odds of mortality in this patient cohort. Conclusion BBC-VTE is a contemporary multi-ethnic cohort of patients providing insights into the risk factors among multi-ethnic patients that have developed VTE. Ethnicity did not emerge as an independent risk for VTE mortality. Funding Acknowledgement Type of funding sources: None.

AML-151 Characteristics of Acute Promyelocytic Leukemia Hospitalizations in the United States

There is a paucity of contemporary population-based data on acute promyelocytic leukemia (APL) in the United States (US). To determine epidemiology of APL admissions and their predictors of mortality. Retrospective analysis utilizing National Inpatient Sample to identify APL admissions (International Classification of Diseases 10 code: C92.40 {APL not in remission}) from 2016-2019. Age-adjusted incidence rate per 100,000 US adults was estimated using the standard US population from the year 2000. Descriptive analysis was performed after categorizing admissions into ages <60 and ≥60 years. We also studied baseline characters of early (<7 days) and late deaths (≥7 days). Weights were applied to produce national estimates. Overall, annual age-adjusted incidence rate of APL during 2016-2019 was 0.28 (95% Confidence Interval 0.26-0.30) per 100,000 persons. Out of 3,800 admissions, 2,425 were <60 and 1,375 were ≥60 years. Whites (67.7%) represented most admissions followed by Hispanics (15.3%) and Blacks (12.1%). Hispanics were youngest with median age of 40 (27-54) years followed by Blacks & Asian/Pacific Islanders at 47 (29-60 and 37-59 respectively) years and Whites at 56 (39-68) years (p<0.001). Females comprised 42.9% of admissions in the older age group and 50.9% in <60 years (p<0.03). The median length of stay (LOS) was 31 (22-38) days for <60 years and 25 (6-37) days for those ≥60 years (p<0.001). After adjusting for confounders, the mean LOS was 7 days higher in teaching hospitals compared to non-teaching hospitals (p<0.001). Overall inpatient mortality was 12.1% (22.2% for age ≥60 and 6.4% for <60 years {p<0.001}) and 56.5% deaths happened before 7 days with median time to death being 6 (3-15) days. The proportion of early deaths in non-teaching hospitals was higher than late deaths (19.2% vs. 5%; p<0.03). On multivariable analysis, older age, invasive mechanical ventilation, acute kidney injury, and gastrointestinal bleeding were associated with higher odds of mortality while admission to a teaching hospital and longer LOS were associated with lower odds of dying. Even in the era of arsenic and all-trans-retinoic acid, APL is associated with significant in-hospital mortality specifically in non-teaching hospitals and for older patients.

S575 Rate and Reasons for Non-Elective 30-Day Readmissions for Functional Dyspepsia in the U.S.

Introduction: Functional dyspepsia (FD), a diagnosis of exclusion, has a 10–20% prevalence(1,2). The pathophysiology is unclear, often multifactorial, and involves treatment with a detailed education about its benign nature. Tricyclic antidepressants and psychotherapy are warranted if functional dyspepsia (FD) is refractory or severe (1). Functional dyspepsia (FD) can present with postprandial distress (70% of FD cases) or epigastric pain syndrome (30% of FD cases) (3). FD can decrease quality of life and place a significant cost burden on healthcare services. Our study sought to determine the rate and reasons for 30-day all-cause readmissions for FD to help identify potentially modifiable factors and decrease the burden of readmissions. Methods: From the NRD, we identified all adults discharged with a principal diagnosis of FD after hospitalization from 2016 to 2019. Then, we identified any readmission of the same patient within 30-days for FD, excluding elective and traumatic encounters. Outcomes assessed included 30-day all-cause readmissions, top principal diagnosis for the readmitted patients, comparison of mortality, length of stay (LOS), and total hospital charges (THC) following readmission. Results: 4 917 patients with FD during index admissions were identified. The 30-day all-cause readmission rate was 19.3%. The Kaplan-Meier curve for 30-day all-cause readmissions was split by sex (Figure). There was no significant difference in age and sex distribution between patients with initial hospitalizations and those with readmissions. The most common reasons for readmissions in patients with FD were gastroparesis (5.9%), FD (5.8%), sepsis unspecified (5.2%), unspecified nausea and vomiting (3.1%), unspecified abdominal pain (2.1%), and acute renal failure (2.0%). Readmission was associated with higher odds of mortality (2.8% vs. < 0.01%, p< 0.001), longer LOS (6.0 vs. 5.0 days, p< 0.001), and higher THC. Over the period, readmissions for FD accounted for a cumulative 5.694 days of hospitalization, costing over $14 million. Conclusion: 1 in 4 patients was readmitted with FD within 30 days. Gastroparesis contributed more to readmissions than a primary diagnosis of FD. Higher rates of poorer outcomes were found with 30-days readmissions. Cohort studies are needed to validate these results.Figure 1.: Survival estimates for 30-day all-cause readmissions in male and Female patients with functional dyspepsia

S1224 Outcomes of Transcatheter Tricuspid Valve Replacement in Patients With Liver Cirrhosis

Introduction: Patients with liver cirrhosis who undergo cardiac surgery are at increased risk of postoperative mortality and morbidity. Patients with cirrhosis have pathophysiologic changes that put them at an excessive risk of coagulopathy, hemorrhage, infection, and multiorgan dysfunction. The prevalence of tricuspid valve (TV) disease is rising but it is often undertreated due to increased mortality associated with TV surgery. Liver dysfunction is seen in the majority of patients with TV disease, but there is a lack of data regarding the impact of cirrhosis on prognosis after TV surgery. Our study aimed to look at the clinical outcomes of patients with liver cirrhosis undergoing TV replacement. Methods: Data were extracted from the National Inpatient Sample (NIS) database from 2016 to 2019. Using the International Classification of Diseases, 10th revision, and Clinical Modification (ICD-10-CM) codes to obtain baseline demographic data, in-hospital mortality, hospital charges, and hospital length of stay (LOS). Statistical analyses were completed using t-test and Chi-squared analysis. Multivariate analysis for the mortality odds ratio (OR) was calculated after adjusting for possible confounders. Results: A total of 9,360 patients who underwent replacement of TV were identified, and 355 of these patients had liver cirrhosis. The mean age of the cirrhosis vs non-cirrhosis group was 56 years vs. 48 (P < 0.001). There was no difference in gender, race, smoking status, and obesity between both groups. However, the cirrhosis group had more prevalence of congestive heart failure (CHF), atrial fibrillation (Afib), hypertension (HTN), chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), and alcohol use compared to the non-cirrhotic group. There was no statistically significant difference in mortality between the two groups (OR 0.72; P = 0.54). There was no difference in total hospital charge ($414,908 vs. 444,556; P < 0.56), or LOS (20 vs. 23 days; P = 0.22). CHF and CKD were independently associated with higher odds of mortality. Conclusion: In our study, we found that cirrhosis did not adversely affect TV replacement outcomes. TV disease is associated with hepatic congestion and TV replacement can potentially improve liver function. So clinicians should consider TV replacement in cirrhotic patients as it is a safe treatment option. However, further large-scale randomized controlled studies are needed to look at the long-term prognosis of these patients.Figure 1.: Multivariate logistic regression for the effect of cirrhosis on patients undergoing TV replacement Table 1. - Demographics and clinical characteristics of the study population Variable No cirrhosis Cirrhosis P-value Age (mean, yr) 48 56 < 0.001 Gender (%) 0.2 Male 41.3% 49.3% Female 58.7% 50.7% Race (%) 0.38 White 71% 63% Black 10% 10% Hispanic 7% 8% Others 12% 19% Comorbidities (%) Alcoholism 3.3% 17% < 0.001 Smoking 45% 42% 0.66 Obesity 11% 17% 0.13 DM 13% 21% 0.056 HTN 44% 60% 0.006 CHF 49% 77% < 0.001 A.Fib 35% 63% < 0.001 HCC 0.11% 0% 0.77 Cachexia 1.8% 1.4% 0.79 COPD 8.8% 19% 0.001 CKD 21% 36% 0.001

Epidemiology and ventilation characteristics of confirmed cases of severe COVID-19 pneumonia admitted in intensive care unit (EPIC19): A multicentre observational study.

Coronavirus disease (COVID)-19 has spread across the globe. For a country like India with limited resources and a high population, it is worth knowing how these patients were managed. This prospective study was aimed to evaluate the patient characteristics and risk factors associated with mortality. The study was conducted from 15 June 2020 to 31 December 2020 in four centres across India. Patients above 18 years of age admitted in the intensive care unit (ICU) with severe COVID-19 pneumonia were included. Details of oxygen therapy and ventilator characteristics were collected for seven days. Of 667 patients included in the study, the average age was 57 (standard deviation (SD) = 15) years and 70.46% were male. The ICU mortality was 60%. Acute physiology, age and chronic health evaluation (APACHE II) score was 29.8 (SD = 6.1). Among various significant risk factors, the need for invasive ventilator support on day 1 [odds ratio (OR): 3.11, 95% confidence interval (CI) (1.91-5.08)] and the development of arrhythmia [OR 3.85 CI (1.69,8.77) confidence interval (CI) (1.69, 8.77)] had higher odds of mortality. PF ratio [partial pressure of arterial oxygen/fraction of inspired oxygen] was 109.31 (77.79-187.26), maximum positive end-expiratory pressure was 10.29 (3.5) cmH2O, driving pressure was 18.22 (6.16) cmH2O, static compliance was 24.20 (8.57) ml/cmH2O and dynamic compliance was 17.55 (5.18) ml/cmH2O on day 1. Proning was used in 67 (22.41%) intubated patients and 44 (11.96%) awake patients. In this cohort of patients, ICU mortality was 60%. The reason for higher mortality could be the severity of illness as suggested by day 1 PF ratio and APACHE II score.

S110 Racial Differences in the Performance of Endoscopic Retrograde Cholangiopancreatography (ERCP) in Acute Cholangitis: A Nationwide Time Trend Analysis, 2008-2018

Introduction: Black race was shown to have high mortality from acute cholangitis (AC) previously (1998-2009) and to undergo less endoscopic retrograde cholangiopancreatography (ERCP) (2009-2012). We conducted a longitudinal racial breakdown of ERCP performed in AC in the USA over 11 years (2008-2018). Methods: This is a retrospective longitudinal trend analysis using National Inpatient Sample. Adult patients (≥18 years old) with AC were identified. Multivariate linear or logistic regression was performed when appropriate. To control for the severity of AC, we also included severe sepsis, septic shock, systemic inflammatory response syndrome with acute organ dysfunction, acute renal failure, acute respiratory failure, thrombocytopenia, altered mental status, and abnormal coagulation in the regression model. Stata (v.14.2) was used to perform analyses considering a 2-sided P-value< 0.05 as statistically significant. Results: A total of 312,849 patients with AC were included in the analysis. Before 2015, the longitudinal trend for the overall total and early ERCPs performed in Whites and Hispanics was increasing (P< 0.01) (Table). The trend was stable in Asians but in Blacks, even though the trend for early ERCP was increasing (P< 0.01) but the overall ERCPs performed for AC remained the same (P=0.07). After 2015, the trends for both early and total ERCPs remained stable for all races (P >0.05). However, upon examining the proportion of early ERCPs among total ERCPs performed, Blacks represented the racial category with the lowest numbers (Figure). Even though the trend of proportions for all racial categories was increasing (P< 0.01) however, the rate of increase was lowest for Blacks (per year increase for Whites was 1.37%, Blacks 1.18%, Hispanics 1.47%, and 1.37 for Asians). Racial mortality comparison showed that compared to Whites, Blacks had the highest odds of mortality (for Blacks, adjusted odds ratio (aOR) 1.86, P< 0.01, Hispanics aOR 1.29, P< 0.01, Asians aOR 1.30, P=0.01). Conclusion: The modification in International Classification of Diseases (ICD) coding in 2015 resulted in an apparent sharp change in the proportion of ERCPs performed due to coding change. Even though the trend for the performance of early ERCP for AC is on the rise in all races, there still exists a racial disparity in the use of early ERCP. The black population was at risk of receiving lower rates of early ERCP (calculated as a fraction of total ERCP), which may impart higher mortality.Figure 1.: Trend for the proportion of early ERCP comparing to total ERCP (ERCP: endoscopic retrograde cholangiopancreatography, AC: acute cholangitis, %: percentage, ICD: International Classification of Diseases) Table 1. - Trends for early and total ERCP performance in acute cholangitis Year 2008 2010 2012 2014 P value a,b 2016 2018 P value a,b White Total ERCP, % 47.58 48.75 50.21 50.55 < 0.01 33.42 32.55 0.37 Early ERCP, % 24.43 25.60 28.38 29.01 < 0.01 18.89 18.90 0.99 Black Total ERCP, % 41.20 39.75 43.59 43.45 0.07 30.97 30.21 0.72 Early ERCP, % 17.34 18.09 22.58 21.93 < 0.01 13.96 14.72 0.66 Hispanic Total ERCP, % 53.87 53.85 56.36 58.14 < 0.01 35.61 35.51 0.96 Early ERCP, % 28.70 27.64 31.94 34.36 < 0.01 17.64 20.28 0.13 Asians Total ERCP, % 54.34 52.86 55.28 53.04 0.84 35.08 37.58 0.39 Early ERCP, % 31.69 27.32 33.45 33.18 0.31 17.16 22.33 0.27 ERCP: endoscopic retrograde cholangiopancreatography.aLinear P trend values.bTime-interrupted trends (before and after 2015) were obtained due to International Classification of Diseases (ICD) coding change from ICD-9 to ICD-10 in 2015.

General Anesthesia Versus Nongeneral Anesthesia for Patients With Acute Posterior Circulation Stroke Undergoing Endovascular Therapy: A Systematic Review and Meta-analysis.

There is continued controversy regarding the optimal anesthetic technique for endovascular therapy in patients with acute posterior circulation ischemic stroke. To compare the clinical outcomes general anesthesia (GA) and non-GA, we performed a systematic review and meta-analysis of randomized controlled trials and observational studies focused on the anesthetic management for endovascular therapy in patients with acute posterior circulation stroke, without language restriction. In addition, we compared clinical outcomes among the studies with different non-GA types (conscious sedation or local anesthesia). Outcome variables were functional independence, excellent outcomes, favorable outcomes, mortality, successful recanalization, hemodynamic instability, intracerebral hemorrhage, and respiratory or vascular complications. Eight studies including 1777 patients were identified. Although GA was associated with a lower odds of functional independence at 90 days (odds ratio [OR]: 0.55; 95% confidence interval [CI] 0.38 to 0.81; P =0.009), substantial heterogeneity was noted ( I2 =65%). Subgroup analysis showed that GA was associated with higher odds of mortality than conscious sedation (OR: 1.83; 95% CI, 1.30 to 2.57; I2 =0%), but there was no difference between GA and local anesthesia ( I2 =0%). Interestingly, subgroup analysis did not identify a relationship between functional independence and GA compared with local anesthesia (OR: 0.90; 95% CI, 0.64 to 1.25; P =0.919; I2 =0%). This meta-analysis demonstrates that GA is associated with worse outcomes in patients with acute posterior circulation stroke undergoing endovascular therapy based on current studies.