In-hospital Death Research Articles

The association of the dietary inflammatory potential with risk of overall and site-specific cancers: A community-based longitudinal study in the UK Biobank

ObjectivesThe association of the dietary inflammatory potential with cancer risk remains uncertain. We examined the relationship of the dietary inflammatory potential with risk of overall and site-specific cancers and explored its sex and age differences. DesignA community-based longitudinal study. SettingParticipants from the UK Biobank completed baseline surveys during 2006–2010 and were followed for up to 15 years to detect incident cancer. Participants170,899 cancer-free participants with dietary data available (mean age: 55.73 ± 7.95, 54.10% female). MeasurementsAt baseline, dietary intake was assessed with a 24-h dietary record for up to 5 times. The inflammatory diet index (IDI) was calculated to assess the dietary inflammatory potential as a weighted sum of 31 food groups (including 14 anti-inflammatory and 17 pro-inflammatory) based on plasma high-sensitivity C-reactive protein (hsCRP) levels, and tertiled as low (indicating low-inflammatory diet), moderate, and high IDI (as reference). Overall and site-specific cancers were ascertained via linkage to routine hospital admission, cancer registry, and death certificate data. Data were analyzed using Cox regression and Laplace regression. ResultsDuring the follow-up (median 10.32 years, interquartile range: 9.95–11.14 years), 18,884 (11.05%) participants developed cancer. In multi-adjusted Cox regression, low IDI scores were associated with decreased risk of rectal cancer (hazard ratio [95% confidence interval, CI] 0.76 [0.61, 0.94]), thyroid cancer [0.45 (0.27, 0.74)], lung cancer [0.73 (0.61, 0.88)]. However, the association between IDI score and the risk of overall cancer was not significant. Laplace regression analysis showed that 10th percentile differences (95% CIs) of cancer onset time for participants with low IDI scores was prolonged by 1.29 (0.32, 2.27), 1.44 (0.58, 2.30), and 2.62 (0.98, 4.27) years for rectal cancer, thyroid cancer, and lung cancer, respectively, compared to those with high IDI scores. Stratified analysis revealed that low IDI scores were associated with a lower risk of rectal cancer (p interaction between IDI score and sex = 0.035) and lung cancer in males, but not in females, and with a reduced risk of thyroid cancer in females, but not in males. Moreover, low IDI scores were associated with a reduced risk of rectal cancer and lung cancer in the participants aged ≥60 years, but not in those <60 years, and with a reduced risk of thyroid cancer in those aged ≥60 years and <60 years. ConclusionsA low-inflammatory diet is associated with decreased risk and prolonged onset time of rectal cancer and lung cancer, especially among males and individuals aged ≥60 years, and thyroid cancer among females.

Potential organ donors during two years at the second largest hospital in Norway.

Western Norway has the lowest number of actual deceased organ donors per million inhabitants in Norway. We wished to find the total number of potential donors and donor organs during 2 years at Haukeland University Hospital, the largest hospital in the region, and evaluate where and why potential donors were lost. We evaluated all patients who died at Haukeland University Hospital in 2018-19. We checked if intensive care patients, filling the criteria as organ donors after brain death, became donors, and the reasons why potential donors were lost. We also estimated the number of potential donors after circulatory death. We checked if patients transferred from the intensive care units and patients never admitted to intensive care were potential donors. Location, gender, age, and possible number of organs were registered. Of 1453 in-hospital deaths, 20 brain-dead patients became actual donors. One brain-dead and two other potential donors, one of them discharged to a bed ward, were not evaluated at the intensive care units. Relatives refused in five patients. Three fulfilled the Norwegian criteria from 2021 as organ donors after circulatory death. Ten potential donors after brain death were never admitted to intensive care and died on neurological or neurosurgical wards. If all potential organ donors were realised, the number of donors would double. The number of transplanted organs would increase less, as organs used per donor would drop from 3.50 to 2.90. Our study cannot explain the low number of donors in our region compared with the rest of Norway. If all potential donations were implemented, the number of actual donors would double. Patients dying outside the intensive care units represent the largest potential source for extra donors, maximally increasing the number of donors by 42%, high-quality livers 44% and kidneys 18%. Introducing organ donation after circulatory death may increase the number of donors by 15% and the number of high-quality livers and kidneys by 12%.

Impact of comorbidities on survival and complications in patients implanted with leadless pacemakers: a national, multicenter study

Abstract Background The number of leadless cardiac pacemaker (LCP) implantations has increased over the recent years, being more frequently performed in elderly patients with multiple comorbidities. Purpose The aim of this study is to analyze periprocedural complications and outcome of LCP patients according to their comorbidity status. Methods This is a Swiss multi-centre, retrospective cohort study including all consecutive patients implanted with a LCP (Medtronic Micra VR or AV) between 2015 and 2022. Charlson Comorbidity Index (CCI) was determined and patients were divided into two groups: CCI ≤ 5 (low comorbidity) and CCI &amp;gt; 5 (high comorbidity). Periprocedural complications, in-hospital death, and all-cause mortality were assessed. Results A total of 863 patients (median age 81 years (IQR 76 – 86), male sex 65%) were included in the study, of which 58% had a CCI ≤ 5. Baseline characteristics of the 2 groups are summarized in the table. Patients in the high comorbidity group were older male presenting more frequently with ischemic cardiomyopathy, diabetes, chronic obstructive pulmonary disease, moderate to severe chronic kidney disease and malignancies. Urgent implantations were more frequent in the high comorbidity than in the low comorbidity group (65% vs. 50%, p&amp;lt;0.001). Overall periprocedural complication rate was 2.9% (n = 25) without significant differences between the two groups (2.9% in both groups, p = 1.0). Pericardial effusion requiring pericardiocentesis was the most frequent periprocedural complication (n = 8, 0.9%). Median hospitalization was significantly longer (5 vs. 3 days, p&amp;lt;0.001), and in-hospital mortality significantly higher (3.6% vs. 0.6%, p=0.002) in the high comorbidity group. None of the in-hospital deaths was deemed a periprocedural complication. Median follow-up was 15.4 months. As shown in the figure, all-cause mortality was significantly higher in the high morbidity group (HR 2.9, 95%-CI 2.2-3.8, p&amp;lt;0.001) resulting in a mortality of 58% at 3 years. Conclusions LCP implantation in patients with multiple comorbidities was equally safe with similar peri-procedural complication rates as compared to patients with less comorbidities. However, both in-hospital death and all-cause mortality during follow-up were significantly higher in the high comorbidity group, because patients were older and sicker. Given that costs of LCPs are substantially higher than standard transvenous pacemakers, further studies are necessary to assess cost-effectiveness in patients with high comorbidity and reduced life expectancy.Figure - Survival estimate according CCITable - Baseline characteristics

Incidence and predictors of heart failure events following cardiac surgery in patients with atrial fibrillation - insights from the LAAOS-III trial

Abstract Background Atrial fibrillation (AF) is a common comorbidity in patients undergoing cardiac surgery and further increases the risk of incident heart failure (HF). However, only limited data exist on HF events following surgery in patients with AF. Methods The Left Atrial Appendage Occlusion Study (LAAOS) III was a randomized trial evaluating concomitant left atrial appendage occlusion in patients with AF undergoing cardiac surgery. In this secondary analysis, we aimed to identify independent predictors of the composite outcome of HF hospitalization or HF-related death following discharge, using a multivariable Cox model – incorporating sex, age (≥65 vs &amp;lt;65 years), systolic blood pressure (≤140 vs &amp;gt;140 mmHg), body mass index (BMI; &amp;lt;25 vs 25-29.9 vs ≥30 kg/m2), diabetes mellitus (DM), prior HF diagnosis, prior stroke, ischemic heart disease (IHD), heart valve surgery, AF history duration, rhythm on discharge electrocardiogram, and trial allocation. Supplementary analyses were undertaken to further assess the continuous variables using cubic spline regression. Results Of 4770 patients enrolled, in-hospital death occurred in 201 (4.2%) and complete discharge data were available for 4564 (95.7%). During a median follow up of 3.9 years, 533 (11.7%) of 4564 patients were hospitalized for HF. In total, 873 (19.1%) died after discharge, including 95 HF-related deaths. The composite outcome of HF hospitalization or HF-related death occurred at an annualized event rate of 3.31%/year [95% confidence interval: 3.04-3.60]. The independent risk factors included age (event rate of 3.64%/year vs 2.03%/year for ≥65 vs &amp;lt;65 years; hazard ratio (HR) 1.71 [1.32-2.21]), DM (4.71%/year vs 2.71%/year for with vs without DM; HR 1.59 [1.34-1.90]), prior HF diagnosis (4.27%/year vs 2.17%/year for with vs without HF; HR 2.00 [1.66-2.41]), IHD (3.63%/year vs 2.85%/year for with vs without IHD; HR 1.26 [1.03-1.54]), AF history duration (3.81%/year vs 2.89%/year for &amp;gt;2 vs &amp;lt;0.5 years; HR 1.23 [1.01-1.50]), and AF rhythm at discharge (3.87%/year vs 2.68%/year for AF vs non-AF rhythm; HR 1.31 [1.09-1.58]). The supplementary spline analyses further revealed a positive correlation between BMI and the risk of the composite outcome (p-value 0.042). Conclusions In patients with AF undergoing cardiac surgery, post-discharge HF hospitalization and HF-related death occurred at a rate of 3.31% per year. Our study identified several significant risk factors including advanced age, higher BMI, DM, prior HF diagnosis, IHD, AF history &amp;gt;2 years, and AF rhythm at discharge.The associations of HF with age and BMI

P.097 Glioblastoma treatment, end-of-life resource utilization, and outcomes in Ontario

Background: The end-of-life (EoL) phase of care is pivotal for glioblastoma (GBM) patients. While early integration of palliative care has shown benefits in various cancer types, its role in GBM care remains underexplored. This study aims to characterize EoL care patterns in GBM patients, assessing their temporal evolution, regional disparities, and socioeconomic influences. Methods: This is retrospective study of all patients with GBM treated in Ontario between 1994 and 2018 using the ICES data repository. Variables analyzed included patient demographics, comorbidities, palliative care utilization, and aggressive/supportive care components. Results: We identified 9,013 GBM patients within the study period. There was a gradual increase in palliative care utilization over time, accompanied by a decrease in in-hospital deaths. However, the proportion of patients receiving chemotherapy in the last 14 days of life increased. Multivariate logistic regression found socioeconomic status influenced palliative care access and rural patients also had a higher rate of in-hospital deaths, possibly due to limitations in outpatient palliative care services. Conclusions: The findings in this study clarify the status of EoL care for GBM patients within Ontario, and demonstrates key areas for future research, underscoring the need for standardized EoL care practices to enhance the quality of care for GBM patients.

Predictive model for post-induction hypotension in patients undergoing transcatheter aortic valve implantation: a retrospective observational study

PurposePost-induction hypotension (PIH) is an independent risk factor for prolonged postoperative stay and hospital death. Patients undergoing transcatheter aortic valve implantation (TAVI) are prone to develop PIH. This study aimed to develop a predictive model for PIH in patients undergoing TAVI.MethodsThis single-center retrospective observational study included 163 patients who underwent TAVI. PIH was defined as at least one measurement of systolic arterial pressure <90 mmHg or at least one incident of norepinephrine infusion at a rate >6 µg/min from anesthetic induction until 20 min post-induction. Multivariate logistic regression analysis was performed to develop a predictive model for PIH in patients undergoing TAVI.ResultsIn total, 161 patients were analyzed. The prevalence of PIH was 57.8%. Multivariable logistic regression analysis showed that baseline mean arterial pressure ≥90 mmHg [adjusted odds ratio (aOR): 0.413, 95% confidence interval (95% CI): 0.193–0.887; p=0.023] and higher doses of fentanyl (per 1-µg/kg increase, aOR: 0.619, 95% CI: 0.418–0.915; p=0.016) and ketamine (per 1-mg/kg increase, aOR: 0.163, 95% CI: 0.062–0.430; p=0.002) for induction were significantly associated with lower risk of PIH. A higher dose of propofol (per 1-mg/kg increase, aOR: 3.240, 95% CI: 1.320–7.920; p=0.010) for induction was significantly associated with higher risk of PIH. The area under the curve (AUC) for this model was 0.802.ConclusionThe present study developed predictive models for PIH in patients who underwent TAVI. This model may be helpful for anesthesiologists in preventing PIH in patients undergoing TAVI.

In-hospital outcomes of anterior versus non-anterior st elevation myocardial infarction complicated with complete atrioventricular block

Abstract Background Complete atrioventricular block (CAVB) is an infrequent complication of acute ST-elevation myocardial infarction (STEMI), and information on its outcomes is scarce. We aimed to address the characteristics and in-hospital outcomes of patients with anterior versus non-anterior STEMI complicated with CAVB in a contemporary, nationwide, all-comer registry, in the U.S. Methods Using the National Inpatient Sample (NIS) database, we identified patients who were hospitalized with STEMI, complicated with CAVB between 2016- 2019. Patients with any cardiac implantable electronic device (CIED) in-situ were excluded. Baseline characteristics, in-hospital procedures and outcomes including time to temporary or permanent pacemaker (PPM)/implantable cardioverter defibrillator (ICD) implantation, length of stay and mortality were collected. Results A total of 17470 patients, were hospitalized with a primary diagnosis of STEMI and concomitant diagnosis of CAVB, 2755(15.8%) with Anterior and 14715(84.2%) with non-anterior STEMI. Non-anterior STEMI patients included more women, had higher prevalence of hypertension, dyslipidemia, smoking history and chronic pulmonary disease, while anterior STEMI patients had higher prevalence of chronic kidney disease and ischemic cardiomyopathy. Anterior STEMI patient had significantly higher rate of in hospital death [955 (35%) vs 2220 (15%), p&amp;lt;0.001], CPR, VT/VF, cardiac arrest, acute heart failure, respiratory failure, mechanical ventilation &amp;gt;96 hours and acute kidney injury. In both groups 40% received temporary pacemaker, but mean time to implantation was longer in anterior STEMI patients [1.1±3.3 vs 0.3±1.2 days, p&amp;lt;0.001]. Rate of any permanent CIED implantation was also significantly higher in the anterior STEMI patients with longer time to PPM implantation, [3.3±3.5 vs 2.8±2.8 days, p&amp;lt;0.001]. Use of mechanical circulatory support devices was significantly higher in anterior STEMI patients. Conclusion In STEMI patients complicated with CAVB, in-hospital outcomes of anterior STEMI were worse comparing to non-anterior STEMI, with significantly higher rates of in-hospital death, in-hospital complications and CIED implantations.

In-hospital mortality following catheter ablation procedures in Germany: insights from the VARY project

Abstract Background The number of catheter ablation (CA) procedures has increased significantly over the last decade. 102,737 CA have been performed in Germany in 2021. Although CA of different types of arrhythmias is generally considered to be safe, serious complications, including in-hospital death, may occur. There is a paucity of real-world national healthcare data in Germany. Aim To investigate the overall in-hospital mortality in patients undergoing any type of CA procedure in Germany and to identify variables associated with in-hospital mortality. Methods According to the German law German hospitals are obliged to provide a dataset including case data, diagnosis based on the ICD-10-GM, operational and procedural codes to the Institute for hospital remuneration system (InEK) every year. The VARY project aims at analyzing and monitoring these data to report the real world scenario on patients undergoing CA in Germany. As of now, 22 German centers were contacted by the Institute for Myocardial Infarction Research (IHF). Their Data between 2019 and 2023 provided from seven of those centers were used for this analysis. Datasets from ten centers are pending. Five centers were not able to provide their data. The project is supported by the German Heart Foundation. Results A total 21,028 patients underwent inpatient CA. 49 patients (69.4% males) died in-hospital following a CA procedure resulting in an overall in-hospital mortality rate of 0.23%. A percutaneous epicardial ablation approach was used in 6.1% of the patients who died (Group A) compared to 0.3% in the surviving patients (Group B). Radiofrequency ablation was used in 83.7% vs. 72.6%, cryoablation in 10.2% vs 27.1%. Patients who died were older compared to those who survived (mean age: 66.7 ± 14.6 vs. 62.0 ± 14.4 years, p &amp;lt;0.01) and had more comorbidities such as diabetes (19/49 (38.8.%) vs. 2274/20,979 (10.8%), p &amp;lt;0,01), chronic obstructive pulmonary disease (5/49 (10.2%) vs. 555/20,979 (2.6%), p &amp;lt; 0,01) and heart failure (39/49 (79.6%) vs. 5116/20,979 (24.4%), p &amp;lt;0.01). There was no difference with regards to gender between the two groups. The most common arrhythmia in both groups was atrial fibrillation with 67.3% and 75.3% (p &amp;lt; 0.01). Cardiac arrest was observed in 44.9% of patients in group A compared to only 0.3% in group B. The median hospital stay was longer in group A (19.0 (IQR 8.0; 42.0) vs. 2.0 (IQR 1.0; 3.0), p &amp;lt; 0.01). 46/49 (93.9%) patients who died were treated on an intensive care unit for a median time of 13.5 days (IQR 3.8; 33.8) compared to 1272/20,979 (6.1%) (p &amp;lt; 0.01) in group B. A cardiac implantable electronic device implantation or revision was performed in 18.4% patients in group A (4 defibrillator implantations, 2 pacemaker implantations, 5 revisions) compared to 2.9% in group B (survivors). Conclusion Inpatient catheter ablation procedures in Germany are associated with a very low in-hospital mortality comparable to data reported from the US.

#2999 Renal venous congestion as a predictor of poor prognosis in patients with acute decompensated heart failure

Abstract Background and Aims Systemic venous congestion in acute decompensated heart failure (ADHF) is associated with a risk of end-organ damage and high in-hospital mortality. We aimed to assess the prevalence and severity of renal venous congestion using venous excess ultrasound (VExUS) protocol in intensive care unit (ICU) patients with ADHF, and to evaluate the association between type of intra-renal venous blood flow, incidence of acute kidney injury (AKI), and in-hospital death. Method A prospective single-center study included 99 patients who were admitted to the ICU with ADHF (mean age 71.1 ± 12.54 years, 56 (56.6%) males). Inclusion criteria: age ≥18 years, ADHF II–IV, signed informed consent. Exclusion criteria: acute coronary syndrome, severe concomitant diseases, refusal to participate in the study. Upon admission, routine clinical, laboratory and instrumental examinations, lung ultrasound using the BLUE protocol, and assessment of venous congestion using the pulse-wave dopplerography were performed. The presence of continuous blood flow was regarded as the absence of renal venous congestion, while intermittent (biphasic and monophasic blood flow) indicated venous congestion. The diagnosis of ADHF and AKI was established based on generally accepted criteria in accordance with modern international recommendations. All patients received optimal drug therapy. The end point was defined as death from cardiovascular causes during hospitalization. Statistical analysis was performed using SPSS Statistics, version 26.0. Results Upon admission, continuous renal venous blood flow was detected in 17 (17.2%) patients, intermittent in 82 (82.8%): biphasic in 47 (47.5%) and monophasic in 35 (35.3%). The patient groups were comparable in gender, age, frequency of coronary heart disease, diabetes mellitus, anemia. Atrial fibrillation was more common in case of monophasic (p &amp;lt; 0.006), and arterial hypertension in patients with continuous venous blood flow (p &amp;lt; 0.001). Patients with renal venous congestion, compared with patients without signs of congestion, had more severe heart failure: swollen neck veins: 5 (29.4%) vs 21 (45%) vs 28 (60%), p &amp;lt; 0.001; hepatomegaly 12 (72.6%) vs 40 (85.1%) vs 31 (88.6%), p &amp;lt; 0.001; edema 8 (47.3%) vs 40 (85.1%) vs 24 (68.6%), p &amp;lt; 0.001; NYHA functional class IV 8 (47.1%) vs 32 (68.1%) vs 26 (74.6%), p &amp;lt; 0.001; more B-lines on lung ultrasound, M+SD 28.82 ± 8.91 vs 34.38 ± 9.64 vs 35.37 ± 8.72, p &amp;lt; 0.001, higher NTproBNP levels, pg/l, Ме(IQR) 2100 (1800;4560) vs 3418 (2300;8434) vs 4100 (2500;9282), p &amp;lt; 0.001, and albuminuria levels mg/g, Ме(IQR) 85 (29;145) vs 127 (49;248) vs 139 (64;245), p &amp;lt; 0.001. The incidence of AKI (4 (23.5%) vs 23 (49%) vs 31 (88.6%), p &amp;lt; 0.001), and in-hospital death (0 (0) vs 11 (23.4%) vs 12 (34.3%), p &amp;lt; 0.003) was also higher in the group of patients with monophasic renal blood flow. The presence of renal venous congestion on admission was associated with an increased risk of death due to heart failure during hospitalization with RR 1.32 (95% CI: 1.16-2.64), p &amp;lt; 0.001, and RR 1.64 (95% CI: 1.48-2.83), p &amp;lt; 0.001 in patients with biphasic and monophasic renal venous blood flow respectively, and with development of AKI RR 3.29 (95% CI: 1.50-7.24), p &amp;lt; 0.003 in patients with monophasic renal venous blood flow. Conclusion In ICU patients with ADHF, the presence of renal venous congestion, assessed on admission with Doppler ultrasound of the intrarenal veins using the VEXUS protocol, is associated with a high risk of developing AKI and in-hospital death.

#1185 Cardiovascular, renal and mortality risk by the KDIGO risk classification: the first observational study in Japan

Abstract Background and Aims The prevalence of chronic kidney disease (CKD) has been increasing, affecting 850 million people worldwide and 13 million individuals in Japan. CKD is a risk factor for cardiovascular complications including heart failure, and dialysis. KDIGO risk classification is widely used for the management of people with CKD in Japan; however, risk of clinical outcomes by the KDIGO classification in Japanese population is unclear. The aim of this study is to describe the risk of major adverse cardiovascular event (MACE) and renal outcomes according to the KDIGO classification in Japanese clinical practice. Method This study was a cohort study using data collated from the RWD database which includes electronic medical records and claims data from approximately 200 medical institutions across Japan since 2000. Subjects aged ≥18 years with two or more consecutive results of eGFR &amp;lt;90 mL/min/1.73 m2 at least 90 days apart within a 360-day period were included, and those received renal replacement therapy (RRT; dialysis or renal transplantation) before the index date was excluded. The index date was defined as the date of the second eGFR measurement &amp;lt;90 mL/min/1.73 m2 between January 2004 and December 2020. Patients were categorized into KDIGO classification G2-G5 based on their eGFR values and A1-A3 based on urine protein test (quantitative test and urine dipstick) results and into `no urine protein data` if no urine protein test was available. The primary endpoint was MACE that was defined as a composite of myocardial infarction, stroke, heart failure hospitalization, and in-hospital death. The secondary endpoint was renal outcomes defined as a composite of RRT, eGFR decline &amp;gt;50%, eGFR &amp;lt;15 mL/min/1.73 m2, diagnosis of CKD stage 5, and in-hospital death, and was analyzed in the group excluding patients with eGFR &amp;lt;15 mL/min/1.73 m2 or with diagnosis of stage 5 CKD on or before the index date. The risk of MACE and renal outcomes were evaluated using the cox proportional hazards model with G2A1 as a reference. Sensitivity analyses were performed for the population excluding those without urine protein data and for the population with quantitative urine protein test results. Results This study included 543,606 patients who met the criteria. Mean age was 61.6 ± 15.3 years, and 50.1% was male. Of those, 222,246 (40.9%) had no urine protein data. Tables 1 and 2 show hazard ratio (HR) for MACE and renal outcomes, respectively. HR (95% confidence interval) for MACE was 1.17 (1.12-1.21) in G2A2 and 1.16 (1.12-1.20) in G3aA1, showing significantly increased risk in early stages of CKD, and continued to increase as disease advances to 2.83 (2.54-3.15) in G5A3. HR for renal outcomes was similarly significantly increased in early stages of CKD, and further increased to 19.96 (18.62-21.40) in G4A3. Results of two sensitivity analyses, excluding subjects with no urine protein data (n = 321,360, 59.1% of overall population) shown in Table 3 and 4, and excluding patients with no quantitative data (n = 36,615, 6.7% of overall population) showed similar trends, supporting the robustness of primary findings. Conclusion This study is the first to demonstrate the applicability of the KDIGO risk classification in assessing the risk of cardiovascular events, including heart failure, and renal outcomes in Japan. Risk of events was increased from early stages of CKD (G3aA1 and G2A2), suggesting the importance of early diagnosis and therapeutic intervention through appropriate testing. These findings may contribute to better management of people with CKD.

Enhancing surgical outcomes in elderly gastric cancer patients: the role of comprehensive preoperative assessment and support

BackgroundAs the prevalence of gastric cancer rises in aging populations, managing surgical risks and comorbidities in elderly patients presents a unique challenge. The Comprehensive Preoperative Assessment and Support (CPAS) program, through comprehensive preoperative assessments, aims to mitigate surgical stress and improve outcomes by enhancing patient awareness and preparation. This study investigates the efficacy of a CPAS program, incorporating frailty and sarcopenia evaluations, to improve short-term outcomes in elderly gastric cancer patients.MethodsA retrospective analysis was conducted on 127 patients aged 75 or older who underwent surgery with CPAS between 2018 and August 2023, compared to 170 historical controls from 2012 to 2017. Propensity score matching balanced both groups based on age-adjusted Charlson Comorbidity Index and surgical details. The primary focus was on the impact of CPAS elements such as rehabilitation, nutrition, psychological support, oral frailty, and social support on short-term surgical outcomes.ResultsAmong 83 matched pairs, the CPAS group, despite 40.4% of patients in the CPAS group and 21.2% in the control group had an ASA-PS score of 3 or higher (P < 0.001), demonstrated significantly reduced blood loss (100 ml vs. 190 ml, P = 0.026) and lower incidence of serious complications (19.3% vs. 33.7%, P = 0.034), especially in infections and respiratory issues. Sarcopenia was identified in 38.6% of CPAS patients who received tailored support. Additionally, the median postoperative hospital stay was notably shorter in the CPAS group (10 days vs. 15 days, P < 0.001), with no in-hospital deaths. These results suggest that personalized preoperative care effectively mitigates operative stress and postoperative complications.ConclusionImplementing CPAS significantly enhances surgical safety and reduces complication rates in elderly gastric cancer patients, emphasizing the critical role of personalized preoperative care in surgical oncology for this demographic.

#1234 Thrombotic microangiopathy (TMA) response during index atypical haemolytic uremic syndrome (aHUS) hospitalisation

Abstract Background and Aims aHUS is associated with dysregulation of the alternative complement pathway. C5 inhibitors (C5i) improve TMA response and renal recovery, but significant morbidity may remain. Although C5i studies have reported on TMA response rates after treatment discontinuation, TMA response data during index hospitalisation are limited. This study described TMA response during index aHUS hospitalisation using real-world evidence from a large, diverse cohort of presumed incident aHUS in the United States (US). Methods This was a retrospective cohort study of hospitalised adult patients with presumed aHUS with electronic healthcare records in the US Premier Healthcare Database, which contains ∼25% of all US hospitalisations (January 1, 2011–June 30, 2021). aHUS was defined as the presence of an International Classification of Diseases (ICD)-9-CM/ICD-10-CM diagnostic code for TMA or haemolytic uremic syndrome (HUS) and a treatment code for a C5i, without a diagnostic code for secondary causes of TMA/HUS or other C5i indications. Complete TMA response was defined by &amp;gt;25% decline of serum creatinine (SCr) and normalisation of platelets and lactate dehydrogenase (LDH) from index presentation, without renal replacement therapy (RRT) at discharge. Included patients had longitudinal laboratory data; patients with in-hospital death were excluded. Patient demographics, clinical characteristics, treatment patterns, and clinical outcomes were assessed as risk factors. Variables were analysed by Wilcoxon signed-rank test, Kruskal–Wallis test, Fisher's exact test, or Chi-square test, as appropriate. Results Of 634 adult patients hospitalised with presumed aHUS, 556 survived to discharge. SCr, platelet, LDH, and all three TMA response criteria data were available for 21.0% (117/556), 18.9% (105/556), 18.2% (101/556), and 16.5% (92/556) of patients, respectively. Median duration between the first and last laboratory measurement before discharge was 21 days (interquartile range [IQR]: 12–33) for SCr, 21 days (IQR: 14–32) for platelets, and 17.5 days (IQR: 11–27) for LDH. Only 6.5% (6/92) of patients achieved a complete TMA response at discharge, preventing statistical analysis with other parameters. Platelet normalisation occurred in 53.3% (56/105) of patients and was associated with younger median age (39 vs 54 years; P = 0.0167) and median time from admission to C5i (8 vs 10 days; P = 0.0459). LDH normalisation occurred in 29.7% (30/101) and was associated with male sex (60.0% vs 22.5%; P = 0.0005), Hispanic ethnicity (20.0% vs 7.0%; P = 0.0330), and median duration of intensive care unit stay (3.5 vs 8 days; P = 0.0185). A drop of &amp;gt;25% in SCr from admission to discharge occurred in 20.5% (24/117) and was associated with Hispanic ethnicity (16.7% vs 8.6%; P = 0.0089) and no RRT (45.8% vs 14.0%; P = 0.0014). Among patients with mortality data, the association between platelet normalisation and 60-day post-discharge mortality was significant (P = 0.0499). LDH normalisation and a &amp;gt;25% decline in SCr were not associated with 60-day (P = 0.6368 and P = 1.000, respectively) or 365-day (P = 0.4288 and P = 0.7023, respectively) post-discharge mortality. Conclusions In this US population of hospitalised adults with presumed incident aHUS, few patients achieved a complete TMA response at discharge, despite C5i. Small sample size limited assessment of clinical characteristics associated with complete TMA response; however, achievement of each TMA response criterion was associated with unique clinical and patient characteristics. Future efforts should focus on characterising patients with aHUS at high risk at discharge and on developing novel precision therapies to improve outcomes.

#1858 Delirium among patients admitted to a Nephrology ward-risk factors and association with short-term outcomes: an observational prospective cohort study

Abstract Background and Aims To date, delirium is considered one of the most frequent neuropsychiatric acute syndromes among hospitalized populations. In general medicine, the risk factors for delirium are well-established but there are limited data concerning the incidence and predictors of delirium in nephrological patients. The aims of the study were (i) to assess the prevalence and the risk factors for delirium in hospitalized patients with acute kidney injury (AKI) and chronic kidney disease (CKD), and (ii) to evaluate the effect of delirium on in-hospital mortality. Method A cohort of 942 patients admitted to the Nephrology Department of a tertiary-care Hospital from January 2023 to December 2023 were enrolled in a prospective observational study. Delirium was diagnosed by a psychiatrist during the hospitalization. The endpoint was defined as hospital death or hospital discharge. Relevant sociodemographic, nephrological- and medical-related clusters were assessed with logistic uni- and multivariable regression methods to evaluate their association with delirium and in-hospital mortality. A two-tailed value &amp;lt;0.05 was considered significant. Results In the studied group, mean age was 62.85 years, 519 (55.09%) patients being males. The prevalence of delirium was 5.41% (51/942 patients). The delirious patients were older (mean 70.04 vs. 62.44 years; P&amp;lt;0.001) and with a longer duration of hospitalization (13.12 ± 7.90 days vs. 10.76 ± 8.92 days; P=0.007). Univariable regression analysis showed that delirium was associated with age (r=0.117, P&amp;lt;0.001), alcohol abuse (r=0.144, P&amp;lt;0.001), history of stroke (r=0.184, P&amp;lt;0.001), vascular dementia (r=0.125, P&amp;lt;0.001), dehydration (r=0.175, P&amp;lt;0.001), sepsis (r=0.144, P&amp;lt;0.001), and acute kidney injury (AKI) stage 2 and 3 (r=0.155, P&amp;lt;0.001). In multivariable regression analysis, the independent predictors of delirium were: age (adjusted odds ratio (OR) 1.029, 95% confidence interval (CI): 1.002–1.056, P=0.034), alcohol abuse (OR=4.728, 95% CI: 1.968-11.359, P=0.001), history of stroke (OR=3.493, 95% CI: 1.849-6.598, P&amp;lt;0.001), and AKI stage 2 and 3 (OR=2.175, 95% CI: 1.152-4.105, P=0.017). Chronic kidney disease was not associated with a higher risk of delirium (OR=0.583, 95% CI: 0.308-1.110, P=0.097). Delirium was associated with increased in-hospital mortality (47.05% vs. no-delirium 14.36%, P&amp;lt;0.001) and was an independent predictor of in-hospital mortality (OR=3.074, 95% CI: 1.630-5.797, P=0.001). Conclusion In this study conducted on patients hospitalized in a nephrology ward age, alcohol abuse, history of stroke, and AKI stage 2 and 3 were independent risk factors for delirium. Delirium significantly increased in-hospital mortality. The findings of the study emphasize the strong connectivity between AKI and acute brain dysfunction.

#1689 Urosepsis and hypovolemia—the main causes of AKI in nursing home residents

Abstract Background and Aims Nursing home residents are at high risk for acute kidney injury (AKI) due to increased prevalence of comorbidities, prolonged immobilization in bed and altered cognitive function. As our nephrology department is confronted with high addressability of institutionalized adults with kidney impairment, we considered describing the epidemiology of AKI and risk factors for AKI-related mortality in this population. Method All adult patients admitted with AKI (KDIGO creatinine-based diagnostic criteria) in our nephrology department during a 6 months period (1st January-30th June 2023) were included in this study. Patients’ data (age, gender, comorbidities) and AKI-related data (causes, need for dialysis recovery of renal function, death) were compared between institutionalized and non-institutionalized patients. Factors associated with increased risk of death in AKI in nursing home residents were also analyzed. All the data was analyzed using IBM SPSS Statistics 25 (IBM, Corp.); the results were considered significant at P &amp;lt; 0.05. Results During the mentioned period a total of 297 patients with AKI were hospitalized: 57 nursing home residents (19.19%) and 240 patients with community-acquired AKI. The nursing-home residents were significantly older, female gender prevailed and history of stroke was significantly higher than in patients with community-acquired AKI (Table 1); no significant differences were found regarding prevalence of diabetes, chronic heart failure or previous chronic kidney disease. Chronic immobilization in bed was present in all institutionalized patients and in 21 patients with community acquired-AKI (8.75%). Multifactorial AKI, dehydration with hypovolemia and urosepsis were significantly more frequent in nursing-home residents, but there were no differences regarding other causes of AKI (Table 1). Increased prevalence of urosepsis in institutionalized patients was not associated with higher frequency of obstruction of urinary tract. Compared with community-acquired AKI, ICU admission and evolution with multiple organ failure were significantly more frequent in institutionalized patients with AKI, but there were no significant differences regarding the need for hemodialysis/hemodiafiltration, nor regarding the recovery of renal function in survivors. Analyzing factors associated with death in nursing home residents, we found that prolonged hospital stay, ICU admission, sepsis and multiorgan failure were associated with increased risk of in-hospital death (Table 2). Conclusion AKI in chronic institutionalized patients is mainly caused by dehydration and/or non-obstructive urosepsis, is often multifactorial and it is associated with increased risk of multiorgan failure, ICU admission and death. An early recognition and a better awareness of these risk factors in nursing homes can improve the epidemiology and the outcome of this severe disease.

The Initial Results of Physician-Modified Fenestrated-Branched Endovascular Repairs of the Aortic Arch and Lessons Learned From the First 21 Cases.

Physician-modified fenestrated-branched endovascular aortic repair (PM-FBEVAR) for the aortic arch provides a minimally invasive treatment option for patients who are too high-risk for open repair. Improvements in technique are gained with ongoing experience with these complex repairs. This study aims to describe outcomes of arch PM-FBEVAR and technical lessons. A retrospective review of consecutive patients who underwent PM-FBEVAR with zone 0 proximal sealing at a single institution between January 2019 and July 2023 was performed. Cases completed using initial techniques (early technique) were compared with cases using the current techniques (current technique). Modification technique changed to include a self-orienting spine trigger wire and anatomically specific fenestrations or inner branches in the current group. The primary outcome was in-hospital mortality. Secondary outcomes included technical success and 30 day stroke. A total of 21 patients underwent arch PM-FBEVAR, with 7 in the early group and 14 in the current group. Severe comorbidities were present in both groups including chronic obstructive pulmonary disease (COPD) (43% vs 36%), prior open ascending aortic repair (57% vs 43%), and prior stroke (86% vs 21%), respectively. Technical success was the same (86% vs 86%, p=1.0). Fluoroscopy time (56 vs 24 min, p=0.012) and in-hospital death (43% vs 0%, p=0.026) were significantly lower in the current group. A 30 day stroke rate (29% vs 7%, p=0.247) was non-significantly decreased in the current group. All-cause mortality was 100% vs 7% during median follow-up of 8 and 6 months (p<0.001). Three deaths in the early group were related to their aortic arch repair including aortic rupture during endograft advancement and 2 postoperative strokes. There is a significant learning curve associated with aortic arch PM-FBEVAR. This study suggests that gained experience, use of the spine trigger wire technique, and precise creation of fenestrations or inner branches can lead to a shorter procedure time and lower complications. Physician modified fenestrated branched endografting is feasible for the aortic arch. The high rate of stroke and perioperative mortality was reduced with incorporation of self-orienting spine trigger wire and anatomically specific inner branch creation.

Development and validation of a nomogram for predicting in-hospital death in cirrhotic patients with acute kidney injury

BackgroundThe purpose of this study was to develop a nomogram for predicting in-hospital mortality in cirrhotic patients with acute kidney injury (AKI) in order to identify patients with a high risk of in-hospital death early.MethodsThis study collected data on cirrhotic patients with AKI from 2008 to 2019 using the Medical Information Mart for Intensive Care IV. Multivariate logistic regression was used to identify confounding factors related to in-hospital mortality, which were then integrated into the nomogram. The concordance index (C-Index) was used to evaluate the accuracy of the model predictions. The area under the curve (AUC) and decision curve analysis (DCA) was used to assess the predictive performance and clinical utility of the nomogram.ResultsThe final study population included 886 cirrhotic patients with AKI, and 264 (29.8%) died in the hospital. After multivariate logistic regression, age, gender, cerebrovascular disease, heart rate, respiration rate, temperature, oxygen saturation, hemoglobin, blood urea nitrogen, serum creatinine, international normalized ratio, bilirubin, urine volume, and sequential organ failure assessment score were predictive factors of in-hospital mortality. In addition, the nomogram showed good accuracy in estimating the in-hospital mortality of patients. The calibration plots showed the best agreement with the actual presence of in-hospital mortality in patients. In addition, the AUC and DCA curves showed that the nomogram has good prediction accuracy and clinical value.ConclusionsWe have created a prognostic nomogram for predicting in-hospital death in cirrhotic patients with AKI, which may facilitate timely intervention to improve prognosis in these patients.

Palliative care inpatients in Switzerland (2012–2021): characteristics, in-hospital mortality and avoidable admissions

ObjectivesPalliative patients generally prefer to be cared for and die at home. Overly aggressive treatments place additional strain on already burdened patients and healthcare services, contributing to decreased quality of...

Contemporary Prestroke Dual Antiplatelet Use and Symptomatic Intracerebral Hemorrhage Risk After Thrombolysis

Intravenous alteplase (IV-tPA) can be administered to patients with acute ischemic stroke but is associated with symptomatic intracerebral hemorrhage (sICH). It is unclear if patients taking prestroke dual antiplatelet therapy (DAPT) are at higher risk of sICH. To determine the associated risk of sICH in patients taking prestroke dual antiplatelet therapy receiving alteplase for acute ischemic stroke using propensity score matching analysis. This cohort study used data from the American Heart Association and American Stroke Association Get With The Guidelines-Stroke (GWTG-Stroke) registry between 2013 and 2021. Data were obtained from hospitals in the GWTG-Stroke registry. This study included patients hospitalized with acute ischemic stroke and treated with IV-tPA. Data were analyzed from January 2013 to December 2021. Prestroke DAPT before treatment with IV-tPA for acute ischemic stroke. sICH, In-hospital death, discharge modified Rankin scale score, and other life-threatening systemic hemorrhages. Of 409 673 participants, 321 819 patients (mean [SD] age, 68.6 [15.1] years; 164 587 female [51.1%]) who were hospitalized with acute ischemic stroke and treated with IV-tPA were included in the analysis. The rate of sICH was 2.9% (5200 of 182 344), 3.8% (4457 of 117 670), and 4.1% (893 of 21 805) among patients treated with no antiplatelet therapy, single antiplatelet therapy (SAPT), and DAPT, respectively (P < .001). In adjusted analyses after propensity score subclassification, both SAPT (odds ratio [OR], 1.13; 95% CI, 1.07-1.19) and DAPT (OR, 1.28; 95% CI, 1.14-1.42) were associated with increased risks of sICH. Prestroke antiplatelet medications were associated with lower odds of discharge mRS score of 2 or less compared with no medication (SAPT OR, 0.92; 95% CI, 0.90-0.95; DAPT OR, 0.94; 95% CI, 0.88-0.98). Results of a subgroup analysis of patients taking DAPT exposed to aspirin-clopidogrel vs aspirin-ticagrelor combination therapy were not significant (OR, 1.35; 95% CI, 0.84-1.86). Prestroke DAPT was associated with a significantly elevated risk of sICH among patients with ischemic stroke who were treated with thrombolysis; however, the absolute increase in risk was small. Patients exposed to antiplatelet medications did not have excess sICH compared with landmark trials, which demonstrated overall clinical benefit of thrombolysis therapy for acute ischemic stroke.

Sex Difference in Characteristics and Predictors of In-Hospital Mortality Among Patients with COVID-19.

With the surge in the prevalence of coronavirus disease (COVID-19) in Beijing starting in October 2022, hospitalisations have increased markedly. The present study aimed to evaluate factors associated with in-hospital mortality in patients with COVID-19. Using data from hospitalised patients, sex differences in clinical characteristics, in-hospital management, and in-hospital mortality among patients diagnosed with COVID-19 were evaluated. Additionally, predictive factors associated with mortality in 1091 patients, who were admitted to the Beijing Anzhen Hospital (Beijing, China) for COVID-19 between October 2022 and January 2023, were also evaluated. Data from 1091 patients hospitalised with COVID-19 were included in the analysis. The in-hospital mortality rates were 14.9% and 10.4% for males and females, respectively. Multifactorial logistic analysis revealed that lymphocyte percentage (LYM%) (odds ratio [OR] 0.863 [95% confidence interval (CI) 0.805-0.925]; P&lt;0.001), uric acid (OR 1.004 [95% CI 1.002-1.006]; P=0.001), and high-sensitivity C-reactive protein (hs-CRP) (OR 1.094 [95% CI 1.012-1.183]; P=0.024) were independently associated with in-hospital mortality from COVID-19. Among female patients, multifactorial analysis revealed that LYM% (OR 0.856 [95% CI 0.796-0.920]; P&lt;0.001), older age (OR 1.061 [95% CI 1.020-1.103]; P=0.003), obesity (OR 2.590 [95% CI 1.131-5.931]; P=0.024), and high high-sensitivity troponin I level (OR 2.602 [95% CI 1.157-5.853]; P=0.021) were risk factors for in-hospital mortality. Receiver operating characteristic (ROC) curve analysis revealed that the efficacy of LYM% in predicting in-hospital death and its area under the ROC curve (AUC) for predicting in-hospital death in males was 0.800, with a sensitivity of 63.2% and specificity of 83.2%. The AUC for predicting hospital death in females was 0.815, with a sensitivity of 87.5% and specificity of 64.4%. LYM% was a consistent predictor of in-hospital mortality in both sexes. Older age and markers of systemic inflammation, myocardial injury, and metabolic dysregulation were also associated with higher mortality risk. These findings may help identify patients who require closer monitoring and tailored interventions to improve outcomes.

Reinforcement of pimobendan with guideline-directed medical therapy may reduce the rehospitalization rates in patients with heart failure: retrospective cohort study

BackgroundPimobendan reportedly improves the subjective symptoms of heart failure. However, evidence of improved prognosis is lacking. This study aimed to determine whether reinforcing guideline-directed medical therapy (GDMT) improved rehospitalization rates for worsening heart failure in patients administered pimobendan.MethodsA total of 175 patients with heart failure who were urgently admitted to our hospital for worsening heart failure and who received pimobendan between January 2015 and February 2022 were included. Of the 175 patients, 44 were excluded because of in-hospital death at the time of pimobendan induction. The remaining 131 patients were divided into two groups, the reduced ejection fraction (rEF) (n = 93) and non-rEF (n = 38) groups, and further divided into the GDMT-reinforced and non-reinforced groups.ResultsIn patients with rEF, the rate of rehospitalization for heart failure was significantly lower in the GDMT-reinforced group than in the non-reinforced group (log-rank test, P = .04). However, the same trend was not observed in the non-rEF group.ConclusionsReinforcing GDMT may reduce the heart failure rehospitalization rate in patients with pimobendan administration and rEF. However, multicenter collaborative research is needed.Trial registrationIRB Approval by the Nippon Medical School Hospital Ethics Committee B-2021-433 (April 10, 2023).