In-hospital Prognosis Of Patients Research Articles

Adverse Impact of Sodium Bicarbonate Administration on Multiple Outcomes in Acute Pancreatitis Patients With Hyperlactatemia.

Hyperlactatemia is likely to occur among patients with acute pancreatitis (AP). Sodium bicarbonate (SB) therapy could be applied to correct potential detrimental acidic disturbances, but the exact impact of SB treatment is unknown. This study aims to investigate the impact of SB on AP patients complicated with hyperlactatemia. The study was conducted based on the database named Medical Information Mart for Intensive Care-IV (MIMIC-IV). Propensity matching (PSM) and inverse probability weighting (IPTW) were used to balance the baseline differences. Multivariate regression and marginal structural Cox models were performed to investigate the association between SB and multiple outcomes. Three hundred fifty-three AP patients with hyperlactatemia (initial serum lactate, >2.0 mmol/L) were extracted from the MIMIC-IV database. We found that SB treatment was significantly associated with worse multi-outcomes of AP patients with hyperlactatemia (in-hospital mortality: hazard ratio, 2.46; 95% confidence interval, 1.38-4.39; P < 0.01). Further analysis through marginal structural Cox models showed that SB had adverse impact on in-hospital prognosis of patients with severe lactic acidosis (pH < 7.15,lactate > 2.0 mmol/L). Sodium bicarbonate might not be an appropriate treatment for AP patients with hyperlactatemia (lactate > 2.0 mmol/L) or with severe lactic acidosis (pH < 7.15, lactate > 2.0 mmol/L).

Letter by Kataoka, et al. Regarding Article, "Correlation of Serum Laminin Levels with Cardiac Function and In-Hospital Prognosis in Patients with Atrial Fibrillation".

Letter by Kataoka, et al. Regarding Article, "Correlation of Serum Laminin Levels with Cardiac Function and In-Hospital Prognosis in Patients with Atrial Fibrillation".

Reply to Letter by Kataoka, et al. Regarding Article, "Correlation of Serum Laminin Levels with Cardiac Function and In-Hospital Prognosis in Patients with Atrial Fibrillation".

Reply to Letter by Kataoka, et al. Regarding Article, "Correlation of Serum Laminin Levels with Cardiac Function and In-Hospital Prognosis in Patients with Atrial Fibrillation".

Correlation of Serum Laminin Levels with Cardiac Function and In-Hospital Prognosis in Patients with Atrial Fibrillation.

We aimed to investigate the correlation between serum laminin (LN) levels and cardiac function in patients with atrial fibrillation (AF) and its predictive value for in-hospital prognosis. This study included 295 patients with AF who were admitted to the Second Affiliated Hospital of Nantong University from January 2019 to January 2021. The patients were divided into three groups according to the New York Heart Association (NYHA) functional classification (I-II, III, and IV); the LN levels increased with increasing NYHA class (P < 0.05). Spearman's correlation analysis revealed a positive correlation between LN and NT-proBNP (r = 0.527, P < 0.001). Of the patients, 36 had in-hospital major adverse cardiac events (MACEs), of whom 30 had acute heart failure, 5 had malignant arrhythmias, and one had stroke. The area under the ROC curve for predicting the in-hospital MACEs by LN was 0.815 (95% CI: 0.740-0.890, P < 0.001). Multivariate logistic regression analysis revealed that LN could be an independent predictor of in-hospital MACEs (odds ratio: 1.009, 95% confidence interval: 1.004-1.015, P = 0.001). In conclusion, LN may serve as a potential biomarker to evaluate the severity of cardiac function and predict in-hospital prognosis in AF patients.

Elevated albumin corrected anion gap is associated with poor in-hospital prognosis in patients with cardiac arrest: A retrospective study based on MIMIC-IV database.

Cardiac arrest(CA) is one of the most leading causes of death. Most of the indicators which used to predict the prognosis of patients with CA are not recognized. Previous studies have suggested that albumin corrected anion gap (ACAG) is associated with recovery of spontaneous circulation in patients with CA, but the predictive value of ACAG for prognosis has not been investigated. This study aims to explore the relationship between ACAG and prognosis during hospitalization in patients with CA. The baseline data of adult patients with CA hospitalized in the intensive care unit (ICU) from 2008 to 2019 in the American Intensive Care Database (MIMIC-IV, version v2.0) were collected. According to the in-hospital prognosis, patients were divided into survival and non-survival group. Based on the criteria of ACAG level in the previous literature, patients enrolled were divided into normal ACAG (12-20 mmol/L) and high ACAG (>20 mmol/L) group. The basic information of patients during hospitalization were compared and analyzed between the two groups with propensity score matching (PSM). The Kaplan-Meier method was used to compare the cumulative survival rates of normal ACAG and high ACAG groups before and after matching. Restricted cubic spline (RCS) method and multivariate COX proportional hazards regressions were used to analyze whether elevated ACAG was associated with all-cause mortality during hospitalization. A total of 764 patients were included. A matched cohort (n = 310) was obtained after PSM analysis. The mortality rate before and after matching in the high ACAG group was higher than that in the normal ACAG group (χ 2 = 25.798; P < 0.001; χ 2 = 6.258; P = 0.012) The Kaplan-Meier survival analysis before and after matching showed that the cumulative survival rate of the high ACAG group was lower (P < 0.05). RCS analysis showed that ACAG had a non-linear relationship with the risk of in-hospital all-cause mortality (χ 2 = 6.060, P < 0.001). Multivariate COX regression analysis before and after PSM suggested that elevated ACAG was an independent risk factor for all-cause mortality in patients with CA during hospitalization (P < 0.01). Elevated ACAG is associated with increased all-cause mortality in patients with CA during hospitalization, it can be an independent risk factor for poor prognosis in patients with CA and remind clinicians to pay more attention to these patients.

Pulmonary embolism and atrial fibrillation: analysis of data from the SIRENA Russian registry

Aim. To present the clinical characteristics and in-hospital prognosis in patients with pulmonary embolism (PE) and atrial fibrillation (AF).Material and methods. On the initiative of a working group of physicians, the basic principles of an observational prospective study (SIRENA registry) have been developed.Results. Among the 660 patients included in the registry, AF was diagnosed in almost every fourth patient — in 22,9% of cases (n=151), which reflects its high incidence in relation to PE. The prevalence of AF corresponded to such conditions as heart failure (HF) (23,2%; n=153), diabetes (15,6%; n=103), and hypertension (HTN) (65,7% n=400). The diagnosis of AF in most patients is based on the history data (n=144; 95,4%), while the first registered AF episode was verified in 7 patients (4,6%). Patients with AF were characterized by older age, significantly higher prevalence of HF (51,2%), HTN (80,8%), chronic kidney disease (18,5%), stroke or transient ischemic attack (23,2%). It is important to note the low prevalence of anticoagulant therapy (15,3%) in the group of patients with previously diagnosed AF (n=144). The prevalence of thrombolytic therapy in patients with AF was significantly lower than among patients without AF (13,9 vs 25,8% (p=0,026)), which is due to contraindications and underdiagnosis of PE. Given the predominantly senile age, high comorbidity rate in patients with AF, as well as the absence of outpatient anticoagulant therapy, in-hospital mortality in patients with PE and AF was 31,1%, and significantly differed from that in those without AF 12,6% (p=0,001). In the general group, post-mortem diagnosis of PE was noted in 7,7% of cases (n=51), of which the proportion of patients with AF was 54,9% (n=28). A possible explanation for the underestimation of PE in AF patients was an erroneous explanation of its manifestations (tachypnea, tachycardia, lower limb edema) due to concomitant HF.Conclusion. Suspicion for PE in elderly patients with AF and manifestations of HF decompensation, as well as the timely administration of anticoagulant therapy, will prevent both arterial and venous embolism.

The HACOR Score Predicts Worse in-Hospital Prognosis in Patients Hospitalized with COVID-19.

Non-invasive respiratory support (NIRS) is widely used in COVID-19 patients, although high rates of NIRS failure are reported. Early detection of NIRS failure and promptly defining the need for intubation are crucial for the management of patients with acute respiratory failure (ARF). We tested the ability of the HACOR score¸ a scale based on clinical and laboratory parameters, to predict adverse outcomes in hospitalized COVID-19 patients with ARF. Four hundred patients were categorized according to high (>5) or low (≤5) HACOR scores measured at baseline and 1 h after the start of NIRS treatment. The association between a high HACOR score and either in-hospital death or the need for intubation was evaluated. NIRS was employed in 161 patients. Forty patients (10%) underwent intubation and 98 (25%) patients died. A baseline HACOR score > 5 was associated with the need for intubation or in-hospital death in the whole population (HR 4.3; p < 0.001), in the subgroup of patients who underwent NIRS (HR 5.2; p < 0.001) and in no-NIRS subgroup (HR 7.9; p < 0.001). In the NIRS subgroup, along with the baseline HACOR score, also 1-h HACOR score predicted NIRS failure (HR 2.6; p = 0.039). In conclusion, the HACOR score is a significant predictor of adverse clinical outcomes in patients with COVID-19-related ARF.

The detrimental impact of elevated Ferritin to Iron ratio on in-hospital prognosis of patients with COVID-19

Background Acute viral infections, including coronavirus disease 2019 (COVID-19), are characterized by the dysregulation of iron metabolism, resulting in high serum ferritin and low iron levels. Research design and methods This study was aimed to evaluate the prospective impact of iron metabolism dysregulation, as expressed by serum Ferritin to Iron Ratio (FIR), on the in-hospital prognosis of patients with COVID-19. Serum levels of ferritin and iron, as well as other iron metabolism markers and recognized prognostic indicators of COVID-19 severity, were measured in 362 patients consecutively hospitalized for COVID-19. The prospective relationship between FIR and the risk of the composite outcome of intensive care unit (ICU) admission/in-hospital death was analyzed. Results In the population examined (mean age 74±15 years, males 55%), the rates of radiographic signs of pneumonia, respiratory distress, and the need for non-invasive ventilation were higher in patients with high FIR (≥29.2, the 75th percentile) than in those with low FIR (<29.2, the 75th percentile) (p<0.05 for all comparisons). High FIR was associated with a 1.7-fold (HR 1.709, 95% CI 1.017-2.871, p=0.043) higher risk of ICU admission/in-hospital death, irrespective of multiple confounders. Conclusions Increasing FIR values significantly and independently predicts worse in-hospital prognosis in hospitalized patients with COVID-19.

Abstract 13069: Baseline QRS Duration ≫ for &gt;140 msec is Associated With Poor In-Hospital Prognosis of Patients With Acute Myocarditis

Introduction: The clinical manifestation of acute myocarditis (AM) is highly variable, and the mechanisms of this diversity have not been fully elucidated. Hence, it is hard to precisely predict their prognosis, and some cases with AM rapidly progress into cardiogenic shock, resulting in the increased in-hospital mortality. Hypothesis: There are some parameters in the initial presentations to predict the prognosis of patients with AM. Methods: This is a multicenter observational study including hospitalized AM patients between 2007 and 2019. We set the primary endpoint of this study as a composite of in-hospital death from any cause and implantation of ventricular assist devices during the index hospitalization. Results: Of 76 enrolled patients [average age: 42 years; male: 79%; mean left ventricular ejection fraction (LVEF): 41%], 13 patients (17%) developed the composite endpoint, and 8 (11%) died within 10 days after the admission. Patients who experienced the composite endpoint were more likely to be older, and have diabetes, anemia, impaired renal functions, higher creatine kinase-MB, lower LVEF, and longer QRS duration on ECG at admission. In the multivariable logistic regression analysis, QRS duration on ECG at admission was independently associated with the composite endpoint, even after adjusting for confounding factors such as age, sex, and LVEF at admission [OR: 1.31, 95% CI: 1.01-1.72]. The ROC curves for the primary endpoint revealed that the cut-off value of QRS duration at admission were 140 msec (sensitivity: 100%, specificity: 90%, AUC: 0.97). Kaplan-Meier analysis showed that patients with baseline QRS duration &amp;gt; for &gt;140 msec had a significantly higher rate of the primary endpoint than those with QRS duration &lt;140 msec (p&lt;0.001, Figure ). Conclusions: Prolonged QRS duration at admission could predict in-hospital prognosis in patients with AM. We should consider the intensive care and close observation in such a high-risk population with AM.

Adverse in-hospital prognosis in patients with non-ST-segment elevation myocardial infarction with right bundle branch block – red flag ECG and sicker patients

Abstract Introduction Recent recommendations regarding myocardial infarction (MI) underline the adverse prognosis associated with right bundle branch block (RBBB), suggesting that, in some cases of non-ST-segment elevation MI (NSTEMI) with RBBB a primary percutaneous coronary intervention (PCI) strategy should be considered. However, it is unclear if this is due to a more difficult and late diagnosis or to the clinical severity inherent to these patients (pts). Purposes To characterize the NSTEMI with RBBB population and find predictors of worse prognosis. Methods Retrospective analysis of pts included in the Portuguese Registry of Acute Coronary Syndromes with NSTEMI, comparing pts with RBBB (group A) vs without RBBB (group B), regarding clinical and demographic variables, diagnostic and therapeutic approaches. Primary endpoint was heart failure, electrical and mechanical complications and death in the in-hospital period. Results We included 9375 pts, 686 in group A and 8689 in group B. Pts in group A were more likely to be male (p&amp;lt;0.001) and over 75 years old (p&amp;lt;0.001). Also, they were more prone to have cardiovascular risk factors (hypertension - p&amp;lt;0.001, diabetes – p&amp;lt;0.001) and history of coronary artery disease (stable angina p=0.007, previous MI p=0.002 and revascularization, either PCI – p=0.016 or surgery – p&amp;lt;0.001), stroke (p&amp;lt;0.001), chronic kidney disease (p&amp;lt;0.001) and cancer (p=0.025), comparing to pts in group B. There were no differences between time from onset of symptoms and first medical contact or hospital admission between groups. Upon admission, these pts presented more frequently with hypotension (p=0.026), Killip class&amp;gt;II (p&amp;lt;0.001) and atrial fibrillation (p&amp;lt;0.001) than pts in group B. There were statiscally significant differences between groups, regarding the use of inotropes (p&amp;lt;0.001), non-invasive (p=0.008) and invasive ventilation (p=0.018) and temporary pacing (p=0.001), all of them higher in group A. Pts with RBBB were less likely to undergo coronary angiography (CA) (p&amp;lt;0.001). However, among those who did, there were no differences in CA timing (p=0.091), but pts from group A had more frequently multivessel disease (p=0.044) and no revascularization was undertaken (p=0.012). About 16.64% of all pts reached the endpoint, but unfavourable in-hospital outcome was significantly more common in group A (p&amp;lt;0.001). RBBB remained an independent predictor of the endpoint (p=0.032) in a multivariate regression analysis, controlled for other variables (namely gender, age, cardiovascular risk factors, previous evidence of cardiovascular disease, and clinical and coronary anatomy data) – AUC of 0.833. Conclusion Although pts with NSTEMI and RBBB have a poorer in-hospital prognosis, partly due to their bigger clinical complexity (older age, multiple comorbidities and complex coronary anatomy), RBBB itself still remains an independent predictor of worse outcome. Funding Acknowledgement Type of funding sources: None.

Predictive value of CHADS2 and CHA2DS2-VASc scores for coronary artery lesions and in-hospital prognosis of patients with acute ST-segment elevation myocardial infarction

ObjectiveTo evaluate the predictive value of CHADS2 and CHA2DS2-VASc scores for coronary artery lesions and in-hospital prognosis of patients with acute ST-segment elevation myocardial infarction (STEMI).MethodsA total of 524 patients who were diagnosed with STEMI from January 2016 to August 2017 were retrospectively reviewed. The correlation between CHADS2 and CHA2DS2-VASc scores with the patients’ clinical data, number of coronary lesions, Gensini scores, the target vessel and hospitalization time and in-hospital adverse events (AEs) was analyzed.ResultsThe number of coronary lesions in STEMI patients was mainly single and double lesions. The CHADS2 and CHA2DS2-VASc scores were not meaningful for predicting the number of coronary lesions. However, for left main coronary artery lesion, CHADS2 score was significantly increased when the number increased (P < 0.05), but CHA2DS2-VASc score showed no statistical difference (P > 0.05). The incidence of target lesions in STMEI patients was mainly left anterior descending coronary artery (LAD) and right coronary artery (RCA). The two scores were not meaningful for predicting target lesions (P > 0.05). For the severity of coronary lesions, there was positive correlation between CHADS2 score with Gensini score (P < 0.05), but no exact correlation between CHA2DS2-VASc score and Gensini score (P > 0.05). The stratifications of CHADS2 score and CHA2DS2-VASc score were significantly associated with hospitalization time and adverse events during hospitalization (P < 0.05). The high score group had longer hospitalization time and more AEs during hospitalization than the low score group and the middle group statistically (P < 0.05).ConclusionCHADS2 score had a certain value to predict the severity of coronary lesion and the presence of left main coronary artery in STEMI. The CHA2DS2-VASc score had no predictive ability to do it. There was no significant value in predicting the number of coronary lesions and the location of the target lesions in STEMI patients. However, both scores had the predictive ability for patient hospitalization and AEs during hospitalization.

Prevalence of vitamin D deficiency and its prognostic impact on patients hospitalized with COVID-19

Objectives: Although hypovitaminosis D appears to be highly prevalent in patients with coronavirus disease 2019 (COVID-19), its impact on their prognosis remains unclear.Methods: In this study, serum 25-hydroxyvitamin D (Vit-D) level was measured in 200 patients hospitalized with COVID-19. The association between Vit-D and the composite endpoint of intensive care unit (ICU) admission/in-hospital death was explored using univariable and multivariable analyses. Also, serum Vit-D level in patients with COVID-19 was compared with that in age- and sex-balanced COVID-19-negative controls (i.e., 50 inpatients with sepsis).Results: Serum Vit-D level was comparable between patients with COVID-19 and COVID-19-negative inpatients with sepsis (P = 0.397). No significant differences were found in serum Vit-D level according to COVID-19 severity at the time of hospital admission (P = 0.299). Incidence rates of the composite endpoint of ICU admission/in-hospital death did not differ significantly between patients with either Vit-D deficiency (i.e., Vit-D <20 ng/mL) or severe Vit-D deficiency (i.e., Vit-D <12 ng/mL) and those without (31% vs 35% with P = 0.649, and 34% vs 30% with P = 0.593, respectively). Vit-D level and status (i.e., Vit-D deficiency and severe Vit-D deficiency) were not prospectively associated with the risk of the composite endpoint of ICU admission/in-hospital death (P > 0.05 for all Cox regression models).Conclusions: Regardless of the potential usefulness of Vit-D measurement to guide appropriate supplementation, Vit-D does not appear to provide helpful information for the stratification of in-hospital prognosis in patients with COVID-19.

In-hospital prognosis in patients with myocardial infarction and atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The number of patients with myocardial infarction (MI) and atrial fibrillation (AF) is increasing every year. Purpose to assess the incidence of AF among the patients with MI, the features of the in-hospital prognosis among the patients with MI and AF compared with MI without AF. Methods The patients with type 1 MI and preexisting AF have been selected from all MI patients MI admitted in 2013-18. They have formed the main group (100 patients). The control group (200 patients with type 1 MI without AF), has been created by "pair selection" method. Patients in the groups did not differ in gender, age, MI date and had not severe comorbidities. Results 1660 patients with MI were analyzed. AF occurred in 309 patients (18.6% of patients with MI). Preexisting AF was in 59.2%. Patients with MI and AF were older than MI without AF (mean age 75.2 ± 10.1 versus 64.6 ± 12.8, p &amp;lt;0.0001) with women’s prevalence (52.4% versus 35.5%, p &amp;lt;0.0001). Type 1 MI predominates among all patients. Type 2 MI occurred 5 times more often among main group (p &amp;lt;0.0001). 2 groups were adjusted for sex (58% of women in both groups), age (mean age 75.5 ± 8, 7 in the main versus 75.2 ± 8.5 in the control group, p = 0.775). Diabetes (45% versus 31.5%, p = 0.030), previous MI (40% versus 25.5%, p = 0.012) and stroke (21% versus 11.5%, p = 0.037) were more common in the main than in the control. Patients with MI and AF had lower GFR (56.8 ± 19.4 versus 61.7 ± 17.9 ml/min/1.73 m2, p = 0.031), LDL (2.8 ± 0.9 versus 3.3 ± 1.0 mmol/L, p = 0.0002). Patients with AF had a lower left ventricular ejection fraction (55.2 ± 10.5 versus 59.8 ± 10.0 %, p = 0.0005). Significant mitral regurgitation was more common in the main group (53.9% versus 30.3% in the control group, p = 0.0002). There were no differences in the incidence of acute heart failure (HF) Killip’s 3-4 (20% versus 13%, p = 0.127). Patients did not differ in the number of affected coronary artery (p = 0.7327), the level of stenosis (p = 0.1956), in the frequency of revascularization (p = 0.0686). Patients with MI and AF had worse in-hospital prognosis. Pulmonary embolism (PE) (9% in main versus 1% in control group, p = 0.0011), minor bleeding (21% versus 9.5%, p = 0.0057), combined endpoint (stroke + PE + mortality) (19% versus 10.5%, p = 0.0415) were more common in the main group. At discharge, patients with AF had HF III NYHA in 21.8% cases versus 5.5% in patients without AF, p = 0.0001. There were no significant differences in other in-hospital endpoints (recurrent myocardial infarction, stroke, major bleeding, and mortality) between the groups. In-hospital mortality was 13% in the main versus 9.5% in the control group (p = 0.4276). Conclusion AF occurs in 18.6% of patients with MI. Patients with AF and MI are older with female prevalence. Type 1 MI predominates. Patients with type 1 MI and pre-existing AF is a group of high risk because of more severe HF, PE, minor bleeding and combined endpoint (stroke + PE + mortality)

Predictors of in-hospital mortality in patients with acute myocardial infarction due to unprotected left main trunk lesion: insight from the Tokyo Cardiovascular Care Unit network multicenter registry

Abstract Background Acute myocardial infarction (AMI) due to unprotected left main trunk (LMT) lesion remains a clinical challenge because it requires prompt and efficient revascularization in catastrophic clinical presentation. However, predictors of in-hospital prognosis in patients with LMT-AMI are still not fully understood. Purpose To examine the predictors of in-hospital mortality in patients with LMT-AMI. Methods From 20,257 AMI patients in the Tokyo Cardiovascular Care Unit network registry (comprising 72 hospitals) from 2013 to 2017, we identified 371 (1.8%) eligible LMT-AMI patients without a history of coronary artery bypass grafting (CABG) and divided them into two groups: 254 survivors and 117 non-survivors. Measured variables included patient demographics, vital signs, laboratory data on admission, and in-hospital treatment. The outcome was in-hospital mortality. We performed a multivariable logistic regression analysis for in-hospital mortality with adjustment for the following 9 potential confounders, based on previous studies: (1) age, (2) sex, (3) Killip class, (4) ST elevation, (5) wide QRS (&amp;gt;120 msec), (6) the Thrombolysis in Myocardial Infarction (TIMI) grade on initial coronary angiography, (7) number of vessels with significant stenosis other than LMT, (8) renal dysfunction on admission, and (9) plasma glucose on admission. Results Overall, mean age was 70.6±11.8 years and 81.9% were male. ST-elevation myocardial infarction accounted for 61.8%. Cardiac arrest was observed in 102 (33.6%) patients. Percutaneous coronary intervention and CABG were performed in 302 (81.8%) and 63 (17.0%) patients, respectively. Intra-aortic balloon pumping and veno-arterial extracorporeal membranous oxygenation were used in 288 (77.8%) and 81 (21.9%) patients, respectively. In-hospital mortality was 31.5%. Multivariable logistic regression analysis showed that higher in-hospital mortality was significantly associated with Killip class IV (adjusted odds ratio 3.41 [95% confidence interval 1.36–8.56]; reference: Killip I), TIMI grade 0 (3.51 [1.22–10.14]; reference: TIMI grade 3), renal dysfunction (estimated glomerular filtration &amp;lt;60 mL/min/1.73m2; 6.48 [2.53–16.57]), and high plasma glucose on admission (&amp;gt;150 mg/dl; 3.64 [1.33–9.97]). Age, sex, ST-elevation, wide QRS, and multi-vessel disease were not significantly associated with in-hospital mortality. Conclusions LMT-AMI remains life-threatening in the current era of widely available revascularization. Our results showed that haemodynamic compromise, no coronary flow, renal dysfunction, and high plasma glucose on admission were strong predictors of in-hospital mortality after LMT-AMI. Given the high cardiac arrest rate, more aggressive therapeutic measures including mechanical circulatory support may be required to improve the prognosis of LMT-AMI. Funding Acknowledgement Type of funding source: None

In-hospital prognosis of patients with primary and secondary acute heart failure diagnosis

Abstract Introduction Secondary acute heart failure (AHF) during hospitalization for another primary diagnosis is a frequent in-hospital complication. Purpose This analysis aims to describe differences in prognosis of these patients in comparison with patients admitted for AHF (primary AHF diagnosis) and also identify factors associated with in-hospital mortality. Methods This is a sub-analysis of the Acute Heart Failure Global Survey of Standard Treatment (ALARM-HF), which enrolled 4953 patients from 9 countries. All parameters univariately associated with in-hospital mortality in the primary and secondary AHF groups were included in the multivariate logistic regression model. Results Secondary AHF diagnosis was observed in 24.1% (N=1196) of the total study cohort. These patients demonstrated almost double all-cause in-hospital mortality rates compared to patients with primary AHF (16.9% versus 8.9%, p&amp;lt;0.001). In patients with primary AHF, negative prognostic factors included older age (&amp;gt;75 years) (OR 2.01, 95% CI 1.24–3.26, p=0.004), acute coronary syndromes (ACS) (OR 2.71, 95% CI 1.57–4.69, p&amp;lt;0.001), chronic renal disease (OR 2.02, 95% CI 1.13–3.61, p=0.017), presence of cold extremities (OR 2.04, 95% CI 1.23–3.40, p=0.006), in-hospital treatment with CPAP (OR 2.55, 95% CI 1.20–5.41, p=0.014), dobutamine (OR 2.55, 95% CI 1.52–4.28, p&amp;lt;0.001), dopamine (OR 3.03, 95% CI 1.74–5.27, p&amp;lt;0.001) and noradrenaline (OR 4.76, 95% CI 2.32–9.76, p&amp;lt;0.001). Favorable predictors were systolic blood pressure ≥100 mmHg on admission (OR 0.54, 95% CI 0.31–0.94, p=0.031), in-hospital treatment with ACEIs (OR 0.07, 95% CI 0.03–0.16, p&amp;lt;0.001), ARBs (OR 0.30, 95% CI 0.13–0.70, p=0.005) and vitamin-K antagonists (OR 0.06, 95% CI 0.007–0.44, p=0.006). In secondary AHF, independent predictors of in-hospital mortality included left ventricular ejection fraction (LVEF) &amp;lt;40% (OR 2.36, 95% CI 1.17–4.75, p=0.016), age &amp;gt;75 years (OR 2.23, 95% CI 1.09–4.54, p=0.026), ACS (OR 3.55, 95% CI 1.50–8.39, p=0.004), diabetes (OR 2.26, 95% CI 1.23–4.16, p=0.008), pre-admission treatment with digoxin (OR 7.27, 95% CI 1.83–28.87, p=0.005), in-hospital medication with dobutamine (OR 2.43, 95% CI 1.28–4.61, p=0.006), dopamine (OR 2.29, 95% CI 1.12–4.67, p=0.022) and noradrenaline (OR 4.14, 95% CI 1.76–9.76, p=0.001). Covariates independently associated with survival benefit in secondary AHF were pre-admission treatment with diuretics (OR 0.29, 95% CI 0.09–0.88, p=0.030) and in-hospital treatment with ACEIs (OR 0.17, 95% CI 0.07–0.39, p&amp;lt;0.001) and aspirin (OR 0.27, 95% CI 0.11–0.69, p=0.006). Conclusion Patients with secondary AHF experienced a more complicated in-hospital course with worse prognosis, compared to primary AHF. LVEF &amp;lt;40%, age &amp;gt;75 years, ACS, diabetes, pre-admission treatment with digitalis, in-hospital medication with dobutamine, dopamine and noradrenaline were identified as independent negative prognostic factors of in-hospital mortality in secondary AHF patients. Funding Acknowledgement Type of funding source: None

Impact of body temperature at admission on inhospital outcomes in patients with takotsubo syndrome: insights from the Tokyo Cardiovascular Care Unit Network Registry.

Takotsubo syndrome occasionally occurs in patients with fever due to underlying diseases. However, the impact of body temperature on inhospital prognosis of patients with takotsubo syndrome remains unknown. Using the patient cohort in the Tokyo Cardiovascular Care Unit Network Registry from 2013 to 2015, we identified 421 eligible patients whose data on body temperature at admission were available and classified them into three groups: high body temperature group (≥37.5°C; n=27), normal body temperature group (36.0-37.4°C; n=319), and low body temperature group (≤35.9°C; n=75). We compared the patient characteristics and inhospital outcomes among the three groups. On admission, the high body temperature group showed a higher proportion of men and preceding physical triggers, higher heart and respiratory rates, and higher C-reactive protein level than the other groups. Inhospital all-cause mortality was significantly higher in the high body temperature group than in the normal or low body temperature group (18.5% vs. 2.2% vs. 4.0%, respectively, P<0.001). Both cardiac mortality (11.1% vs. 1.3% vs. 1.3%, P=0.001) and non-cardiac mortality (7.4% vs. 0.9% vs. 2.7%, P=0.031) were also significantly higher in the high body temperature group. Multivariable logistic regression analysis showed that high body temperature (reference: normal body temperature) was significantly associated with higher inhospital mortality (adjusted odds ratio 4.22; 95% confidence interval 1.15-15.51; P=0.030). Our findings suggest that high body temperature at admission is a strong predictor of inhospital mortality in patients with takotsubo syndrome. Febrile takotsubo syndrome patients may need to be managed with recognition of life-threatening conditions from the time of diagnosis, no matter what the causes of fever are.

Association Between Off-hour Presentations and In-hospital Mortality for Patients with Acute ST-Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention.

ObjectivesThis study aimed to assess the effect of the admission time (on-hours versus off-hours) on in-hospital mortality in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI) in a region without STEMI network.MethodsWe analysed in-hospital the mortality among 300 consecutive ST-segment elevation myocardial infarction (STEMI) patients treated with PPCI between March 2012 and February 2017. Patients were divided according to admission time into on-hours admission (08:00 AM until 08:00 PM on weekdays) versus off-hours admission (08:00 PM until 08:00 AM on weekdays and 24 h on weekends and holidays). Demographic and clinical data as well as in-hospital mortality were compared between the two groups.ResultsOne hundred and seventy eight (59.3%) patients were admitted during on-hours, and 122 (40.7%) patients were presented in off-hours. The mean door-to-balloon time was 42.3 min in the off-hours group and 34.2 min in the on-hours group with no statistically significant difference (p = 0.39). The mortality rate was 3.9% at on-hours presentation versus 4.09% in off-hours admission (p = 0.58). Multivariate logistic regression analysis showed that off-hours presentation was not associated with in-hospital mortality. [odds ratio (OR) 0.74; 95% CI, 0.21–2.61, p = 0.64].ConclusionDespite no efficient STEMI network in present study, off-hour presentation had no significant impact on in-hospital prognosis in patients with STEMI treated with PPCI. Larger studies are warranted in order to determine the prognostic role of off-hour presentation in patients with STEMI undergoing PPCI.

Charlson comorbidity index scores and in-hospital prognosis of patients with severe acute respiratory infections.

Respiratory infections are one of the leading causes of mortality, and comorbid conditions play a significant role in the severity and fatality of these infections. We evaluated the Charlson Comorbidity Index (CCI) score and possible predictors of mortality in hospitalised patients with severe acute respiratory infection (SARI), aiming to test if the CCI is a valid in-hospital prognostic indicator. Patients older than 14 years, hospitalised from 2010 to 2016 due to SARI by viral infection and who were submitted to respiratory virus testing were included. We assessed comorbidity retrospectively through chart review and calculated four variants of the CCI. Of the 291 patients assessed, 72.8% (n = 212) presented comorbidities, and 24% died (n = 70). The most recurrent comorbidities were chronic pulmonary disease (n = 76/212, 36%) and HIV (n = 50/212, 23.6%). The 1994 age-adjusted CCI predicted in-hospital mortality in SARI patients (P = 0.04), and HIV was associated with in-hospital mortality (P = 0.032). The comorbidity scores used to assess mortality risk in hospitalised patients with SARI displayed poor results, but HIV infection was considered a marker of severity. However, other factors should be considered in order to compose a score system that allows us to specifically assess the risk of mortality in patients with SARI.

O12-2 - Neurohormonal Activation in Very Elderly Patients Over 80years Old with Acute Decompensated Heart Failure

Backgrounds: In heart failure, the adverse effects of neurohormonal activation are known and the suppression of renin aldosterone system is effective to improve the prognosis in clinical trial. However population for these trials is under 80 years old. This purpose is to assess whether neurohormonal factors are activated irrespective of age in patients with acute decompensated heart failure (ADHF). Methods: A total of 360 patients with ADHF were admitted in ICU (77 ± 12 years, male 197) for four years. The number of patients over and under 80 years old were 184 (O group), 176 (U group). Hemodynamics, blood chemistry, neurohormonal factors on admission and pre-hospital medication were studied retrospectively. Results: O group had significantly more female, lower hemoglobin, creatinine, uric acid, plasma rennin activity (PRA) and higher EF (P < .05). Death in hospital was 19 patients (5.3%). In Cox's proportional hazards analysis, higher BUN, logBNP, logPRA were an independent predictor of in-hospital death in all patients (HR1.014, 2.972, 1.839, P < .01). However, higher BUN was an independent predictor of in-hospital death in O group, not U group (HR1.057, 95%CI 1.033–1.081, P < .01). Conclusions: Neurohormonal activation and BUN elevation are the risk factor of in-hospital mortality in ADHF patients, but it is suggested that plasma renin is less activated and neurohormonal factor is not important for in-hospital prognosis in patients over 80 years old.

Electrocardiographic characteristics associated with in-hospital outcome in patients with left main acute coronary syndrome: For contriving a new risk stratification score.

The aim of this study was to evaluate electrocardiographic characteristics associated with in-hospital prognosis in patients with left main acute coronary syndrome. A total of 89 left main acute coronary syndrome subjects were selected from 3357 consecutive acute coronary syndrome patients (2.7%). Patients of this study were divided into two groups; those who survived and those who died. Patients' characteristics and electrocardiogram on admission were then retrospectively analyzed between the two groups. In-hospital mortality was 28.1%. The prevalence and degree of ST-segment elevation at lead aVL were significantly higher in the deceased group than in the survival group ( p<0.001). However, those at lead aVR did not show significant differences between the two groups. Moreover, the width of the QRS-complex was significantly wider (lead V3; p<0.001), and the level of five minus the absolute value of five minus number of ST-segment elevation (5-|5-ST|; due to the highest in-hospital mortality (70%) in the five-lead ST-segment elevation group) was significantly larger in the deceased group than in the survival group ( p<0.001). The odds ratios that predicted in-hospital cardiac death were 1.03 for width of the QRS-complex at lead V3 (95% confidence interval (CI); 1.01-1.06; p=0.003), 1.74 for 5-|5-ST| (95% CI; 1.03-3.00; p=0.040), and 1.44 for ST-segment elevation at lead aVL (95% CI; 0.93-2.23; p=0.100). ST-segment elevation at lead aVL rather than aVR, width of the QRS-complex at lead V3 and number of ST-segment elevation were the prognostic predictors for in-hospital mortality in patients with left main acute coronary syndrome. Electrocardiographic characteristics should be assessed in addition to the established risk score in patients with left main acute coronary syndrome.