Independent Mortality Research Articles

Renal function deterioration is an independent mortality determinant in Koreans diagnosed with lupus nephritis.

To evaluate the predictors of mortality, mortality rate, and causes of death in patients with lupus nephritis (LN) depending on final renal function. The cohort included 401 Korean patients diagnosed with LN between 1985 and 2019. We retrospectively analyzed the clinical and laboratory indices, treatment response, and the final renal function. The final renal function was defined by the last stable level of eGFR measured in an out-patient department more than 3 times before death occurred and was categorized into five groups depending on CKD stage. The median follow-up time after the diagnosis of LN was 131months. No difference in baseline demographic characteristics and laboratory findings was found except for the proportion of Hb less than 10mg/dl and baseline eGFR (p = 0.011 and 0.037). We found no significant differences in therapeutic parameters, but all the response parameters including treatment response at 6months (p = 0.004) and 12months (p = 0.004), time to remission (p < 0.001), final renal response (p < 0.001), and the final renal function (p < 0.001) differed significantly between the two groups. In multivariate Cox proportional hazards analysis, the final renal function was an independent risk factor predicting mortality. The main causes of death were infection and SLE flare. Contrary to existing knowledge, SLE flare also triggered mortality in a few patients with LN progressed to end-stage renal disease (ESRD). Only two cases of mortality occurred in the kidney transplantation (KT) group (n = 25) with a median follow-up period of 224months. The overall mortality rates calculated using the Kaplan-Meier method were 6.8%, 10.3%, 19.7%, and 28.0% at 5, 10, 20, and 30years, respectively. Renal function deterioration was an independent determinant of mortality in Korean patients with LN. SLE flare also caused mortality in patients with LN who required maintenance dialysis, suggesting the benefit of KT on lupus activity and survival.

Prospective evaluation of vitamin D levels in dental treated patients: A screening study.

The available epidemiological data indicates the existence of numerous tooth deficiencies and periodontopathies in the Polish population. Successful surgical treatment is dependent upon multiple factors, including bone quality, which is affected by vitamin D - one of the regulators of calcium (Ca) and phosphorus (P) metabolism. The aim of this study was to conduct a prospective evaluation of the levels of vitamin D among patients receiving dental treatment for various reasons (conservative, surgical or prosthodontic treatment). The study involved 60 patients, who, for various reasons, were admitted for dental treatment for over a 1-week period in the summer season. A thorough interview together with a periodontological examination consisting of probing depth (PD) and clinical attachment level (CAL) measurements, were conducted. A total of 2 mL of blood was collected from each patient to determine the concentrations of vitamin D, parathyroid hormone (PTH), Ca, magnesium (Mg), and P in the blood with the use of mass spectrometry. Among the 60 patients enrolled in the study, 53 (88.3%) showed vitamin D deficiency and 18 (30%) showed a concentration below 17.8 ng/mL, which is an independent general mortality factor. The difference in the level of vitamin D between group A (without periodontitis) and group B (with periodontitis) was not statistically significant (p = 0.076), but a tendency for lower vitamin D levels in people with periodontitis was observed. We also observed a tendency for periodontal disease to occur more often with extreme vitamin D deficiency (<15 ng/mL) (p = 0.730). Low levels of vitamin D are present in a large proportion of dental patients, and an increase in the incidence of periodontal disease is likely associated with a decrease in the level of vitamin D.

Effects of previous coronary artery bypass graft surgery on in-hospital mortality in ST-segment elevation myocardial infarction: National dataset analysis

Association of history of coronary artery bypass graft surgery (CABG) with clinical outcomes in patients presenting with ST-segment elevation myocardial infarction (STEMI) is unclear from current data.Using Nationwide Inpatient Sample (NIS) data from 2003 to 2014, adult patients hospitalized with principal diagnosis of STEMI were extracted. The cohort was divided into patients with a history of CABG and those without a history of CABG. The primary outcome measure was in-hospital mortality (IHM).2,710,375 STEMI patients were included in final analysis of which 110,066 had history of CABG. Patients with history of CABG had higher unadjusted (12.2% vs. 8.8%, P < 0.001) and adjusted (odds ratio [OR]1.16; 95% confidence interval [CI] 1.14 to1.19, P < 0.001) IHM compared to those without previous CABG. Compared to a trend of decreasing IHM in STEMI patients without previous CABG, a trend of increasing IHM was observed over the study period in those with a history of previous CABG. Although patients with previous CABG when treated with primary PCI (PPCI) had a higher unadjusted IHM compared to those without previous CABG, (4.8% vs 4.3%, P < 0.001), after adjusting for comorbidities and in-hospital complications no significant increase in IHM was observed in patients with previous CABG treated with PPCI.STEMI patients with previous CABG have a significantly higher IHM compared to those without previous CABG. PPCI improves IHM with no independent mortality disadvantage attributable to previous CABG.

Clinical and Bacterial Characteristics of Klebsiella pneumoniae Affecting 30-Day Mortality in Patients With Bloodstream Infection.

BackgroundThere is a paucity of studies using clinical characteristics and whole-genome sequencing together to fully identify the risk factors of patients with Klebsiella pneumoniae (KP) bloodstream infection (BSI).MethodsWe retrospectively analyzed the clinical and microbiological characteristics of patients with KP BSI. Isolates were processed using Illumina NGS, and relevant bioinformatics analysis was conducted (multi-locus sequence typing, serotype, phylogenetic reconstruction, detection of antibiotic resistance, and virulence genes). A logistic regression model was used to evaluate the risk factors of hosts and causative KP isolates associated with 30-day mortality in patients infected with KP BSI.ResultsOf the 79 eligible patients, the 30-day mortality rate of patients with KP BSI was 30.4%. Multivariate analysis showed that host-associated factors (increased APACHE II score and septic shock) were strongly associated with increased 30-day mortality. For the pathogenic factors, carriage of iutA (OR, 1.46; 95% CI, 1.11–1.81, p = 0.002) or Kvar_1549 (OR, 1.31; 95% CI, 1.02–1.69, p = 0.043) was an independent risk factor, especially when accompanied by a multidrug-resistant phenotype. In addition, ST11-K64 hypervirulent carbapenem-resistant KP co-harbored acquired blaKPC-2 together with iutA (76.5%, 13/17) and Kvar_1549 (100%, 17/17) genes. Comparative genomic analysis showed that they were clustered together based on a phylogenetic tree, and more virulence genes were observed in the group of ST11-K64 strains compared with ST11-non-K64. The patients infected with ST11-K64 strains were associated with relatively high mortality (47.2%, 7/17).ConclusionThe carriage of iutA and Kvar_1549 was seen to be an independent mortality risk factor in patients with KP BSI. The identification of hypervirulent and carbapenem-resistant KP strains associated with high mortality should prompt surveillance.

1575P Systemic anti-cancer therapy and metastatic cancer are independent mortality risk factors during two UK waves of the COVID-19 pandemic at University College London Hospital

Data from the first wave of COVID-19 infection demonstrated that a history of cancer and SACT was associated with poorer outcomes. Our study compares outcomes for cancer patients matched to non-cancer patients between the two waves in order to explore further how cancer and its treatment may impact COVID-19 mortality.

Severe Lymphopenia as a Predictor of COVID-19 Mortality in Immunosuppressed Patients.

Background. Coronavirus disease 2019 (COVID-19) has a high mortality in certain group of patients. We analysed the impact of baseline immunosuppression in COVID-19 mortality and the role of severe lymphopenia in immunocompromised subjects. Methods. We analysed all patients admitted with COVID-19 in a tertiary hospital in Madrid between March 1st and April 30th 2020. Epidemiological and clinical data, including severe lymphopenia (<500 lymphocytes/mm3) during admission, were analysed and compared based on their baseline immunosuppression condition. Results. A total of 1594 patients with COVID-19 pneumonia were hospitalised during the study period. 166 (10.4%) were immunosuppressed. Immunocompromised patients were younger (64 vs. 67 years, p = 0.02) but presented higher rates of hypertension, diabetes, heart, neurological, lung, kidney and liver disease (p < 0.05). They showed more severe lymphopenia (53% vs 24.1%, p < 0.001), lower SapO2/FiO2 ratios (251 vs 276, p = 0.02) during admission and higher mortality rates (27.1% vs 13.5%, p < 0.001). After adjustment, immunosuppression remained as an independent factor related to mortality (Odds Ratio (OR): 2.24, p < 0.001). In the immunosuppressed group, age (OR = 1.06, p = 0.01), acute respiratory distress syndrome (ARDS) (OR = 12.27, p = 0.017) and severe lymphopenia (OR = 3.48, p = 0.04) were the factors related to high mortality rate. Conclusion. Immunosuppression is an independent mortality risk factor in COVID-19. Severe lymphopenia should be promptly identified in these patients.

National Temporal Trends in Hospitalization and Inpatient Mortality in Patients With Pulmonary Sarcoidosis in the United States Between 2007 and 2018

Sarcoidosis-related hospitalizations have been increasing in the past decade. There is a paucity of data on mortality trends over time in patients with pulmonary sarcoidosis and respiratory failure who are hospitalized. What are the national temporal trends over time in hospitalization and inpatient mortality rates in patients with pulmonary sarcoidosis and respiratory failure hospitalized in the United States between 2007 and 2018? Hospitalization data between 2007 and 2018 were extracted from the National Inpatient Sample for subjects with pulmonary sarcoidosis. Inpatient mortality was stratified by age, respiratory failure, mechanical ventilation (MV), hospital location, and setting (rural vsurban, academic vsnonacademic). A Cochran-Armitage test for trend was used to assess the linear trend in mortality, respiratory failure, and need for MV. Hospitalizations in patients with pulmonary sarcoidosis increased from 258.5 per 1,000,000 hospitalizations in 2007 to 705.7 per 1,000,000 in 2018. Hospitalizations for respiratory failure increased ninefold from 25.9 to 239.4 per 1,000,000 hospitalizations, and the need for MV increased threefold from 9.4 per 1,000,000 in 2007 to 29.4 per 1,000,000 in 2018. All-cause inpatient mortality was 2.6%; however, mortality was 13 times higher in patients with respiratory failure (10.6%vs0.8%) and 26 times higher in patients who required MV (31.2%vs1.2%). Inpatient mortality associated with respiratory failure declined 50%from 17.2%in 2007 to 6.6%in 2018. Independent inpatient mortality predictors were older age (adjusted hazard ratio [aHR], 1.025), respiratory failure (aHR, 3.12), need for MV (aHR, 6.01), pulmonary hypertension (pHTN; aHR, 1.44), pulmonary embolism (aHR, 1.61), and frailty (aHR, 3.10). Hospitalizations for respiratory failure in patients with pulmonary sarcoidosis are increasing; however, inpatient mortality from respiratory failure has declined. Older age, respiratory failure, pHTN, and frailty are important predictors of inpatient mortality in patients with pulmonary sarcoidosis who are hospitalized.

Specialist pneumonia intervention nurse service improves pneumonia care and outcome

BackgroundA specialist pneumonia intervention nursing (SPIN) service was set up across a single National Health Service Trust in an effort to improve clinical outcomes. A quality improvement evaluation was performed...

Limited sink but large storage: Biomass dynamics in naturally developing beech (Fagus sylvatica) and oak (Quercus robur,Quercus petraea) forests of north‐western Germany

AbstractCurrently, the dynamics underlying the storage and acquisition of biomass, and thus carbon, in naturally developing forests are under debate. A better understanding of the biomass dynamics of forests is needed to clarify the role played by naturally developing forests in the mitigation of climate change.Long‐term monitoring data from unmanaged strict forest reserves (SFRs) in north‐western Germany were used to analyse the biomass dynamics of pure beech, mixed beech and mixed oak forests. A complete balance of above‐ground woody biomass (biomass) and growth, density‐dependent and ‐independent mortality, as well as deadwood decay was derived. Density‐independent mortality served as a proxy for disturbance severity.After a time since abandonment (TSA) of 50 years, the average biomass ranged between 334 t/ha in mixed oak and 478 t/ha in pure beech stands. The net change in biomass was positive in all forest types. Density‐independent mortality and decay rates were much lower than the growth rates. Pure beech forests reached higher levels of biomass, a higher net change in biomass, and more growth than either of the mixed forest types. Biomass increased linearly with TSA in pure beech stands but followed an asymptotic course in the mixed forests. In the latter, the net change in biomass and growth were consistent with a unimodal development pattern. The development of biomass could not be explained by the ageing of the tree communities.Synthesis. We hypothesized that the observed biomass dynamics are a result of the interaction between resource supply within a limited growing space and the resource‐use efficiency of the tree stand in conjunction with disturbances. The still‐linear increase in the biomass of pure beech forests was assumed to reflect the high resource‐use efficiency of beech, especially its use of light. The above‐ground capacity of naturally developing broadleaved forests to store and acquire carbon is substantial. Accordingly, allowing broadleaved forests to develop naturally can contribute substantially to carbon storage and sequestration. However, our study also suggests that the above‐ground carbon sink decreases after several decades.

The Impact of Age on Mortality in Chronic Haemodialysis Popu-Lation with COVID-19.

Age and chronic kidney disease have been described as mortality risk factors for coronavirus disease 2019 (COVID-19). Currently, an important percentage of patients in haemodialysis are elderly. Herein, we investigated the impact of age on mortality among haemodialysis patients with COVID-19. Data was obtained from the Spanish COVID-19 chronic kidney disease (CKD) Working Group Registry. From 18 March 2020 to 27 August 2020, 930 patients on haemodialysis affected by COVID-19 were included in the Registry. A total of 254 patients were under 65 years old and 676 were 65 years or older (elderly group). Mortality was 25.1% higher (95% CI: 22.2–28.0%) in the elderly as compared to the non-elderly group. Death from COVID-19 was increased 6.2-fold in haemodialysis patients as compared to the mortality in the general population in a similar time frame. In the multivariate Cox regression analysis, age (hazard ratio (HR) 1.59, 95% CI: 1.31–1.93), dyspnea at presentation (HR 1.51, 95% CI: 1.11–2.04), pneumonia (HR 1.74, 95% CI: 1.10–2.73) and admission to hospital (HR 4.00, 95% CI: 1.83–8.70) were identified as independent mortality risk factors in the elderly haemodialysis population. Treatment with glucocorticoids reduced the risk of death (HR 0.68, 95% CI: 0.48–0.96). In conclusion, mortality is dramatically increased in elderly haemodialysis patients with COVID-19. Our results suggest that this high risk population should be prioritized in terms of protection and vaccination.

Severe Acute Respiratory Infection Surveillance during the Initial Phase of the COVID-19 Outbreak in North India: A Comparison of COVID-19 to Other SARI Causes.

IntroductionWorld Health Organization proposes severe acute respiratory infection (SARI) case definition for coronavirus disease 2019 (COVID-19) surveillance; however, early differentiation between SARI etiologies remains challenging. We aimed to investigate the spectrum and outcome of SARI and compare COVID-19 to non-COVID-19 causes.Patients and methodsA prospective cohort study was conducted between March 15, 2020, to August 15, 2020, at an adult medical emergency in North India. SARI was diagnosed using a “modified” case definition—febrile respiratory symptoms or radiographic evidence of pneumonia or acute respiratory distress syndrome of ≤14 days duration, along with a need for hospitalization and in the absence of an alternative etiology that fully explains the illness. COVID-19 was diagnosed with reverse transcription-polymerase chain reaction testing.ResultsIn total, 95/212 (44.8%) cases had COVID-19. Community-acquired pneumonia (n = 57), exacerbation of chronic lung disease (n = 11), heart failure (n = 11), tropical febrile illnesses (n = 10), and influenza A (n = 5) were common non-COVID-19 causes. No between-group differences were apparent in age ≥60 years, comorbidities, oxygenation, leukocytosis, lymphopenia, acute physiology and chronic health evaluation (APACHE)-II score, CURB-65 score, and ventilator requirement at 24-hour. Bilateral lung distribution and middle-lower zones involvement in radiography predicted COVID-19. The median hospital stay was longer with COVID-19 (12 versus 5 days, p = 0.000); however, mortality was similar (31.6% versus 28.2%, p = 0.593). Independent mortality predictors were higher mean APACHE II in COVID-19 and early ventilator requirement in non-COVID-19 cases.ConclusionsCOVID-19 has similar severity and mortality as non-COVID-19 SARI but requires an extended hospital stay. Including radiography in the SARI definition might improve COVID-19 surveillance.How to cite this articlePannu AK, Kumar M, Singh P, Shaji A, Ghosh A, Behera A, et al. Severe Acute Respiratory Infection Surveillance during the Initial Phase of the COVID-19 Outbreak in North India: A Comparison of COVID-19 to Other SARI Causes. Indian J Crit Care Med 2021;25(7):761–767.

Plasma glutamine status at intensive care unit admission: an independent risk factor for mortality in critical illness

BackgroundA plasma glutamine concentration outside the normal range at Intensive Care Unit (ICU) admission has been reported to be associated with an increased mortality rate. Whereas hypoglutaminemia has been frequently reported, the number of patients with hyperglutaminemia has so far been quite few. Therefore, the association between hyperglutaminemia and mortality outcomes was studied in a prospective, observational study.Patients and methodsConsecutive admissions to a mixed general ICU were eligible. Exclusion criteria were < 18 years of age, readmissions, no informed consent, or a ‘do not resuscitate’ order at admission. A blood sample was saved within one hour from admission to be analysed by high-pressure liquid chromatography for glutamine concentration. Conventional risk scoring (Simplified Acute Physiology Score and Sequential Organ Failure Assessment) at admission, and mortality outcomes were recorded for all included patients.ResultsOut of 269 included patients, 26 were hyperglutaminemic (≥ 930 µmol/L) at admission. The six-month mortality rate for this subgroup was 46%, compared to 18% for patients with a plasma glutamine concentration < 930 µmol/L (P = 0.002). A regression analysis showed that hyperglutaminemia was an independent mortality predictor that added prediction value to conventional admission risk scoring and age.ConclusionHyperglutaminemia in critical illness at ICU admission was an independent mortality predictor, often but not always, associated with an acute liver condition. The mechanism behind a plasma glutamine concentration outside normal range, as well as the prognostic value of repeated measurements of plasma glutamine during ICU stay, remains to be investigated.

Abstract 82: Confirmation and Identification of Incident Cases of Breast Cancer in a Setting with Limited Cancer Registry Coverage: The Mexican Teachers' Cohort

Abstract Purpose: To present the use of administrative databases and registries to confirm and identify incident breast cancer (BC) cases in a prospective cancer cohort in Mexico where cancer registry coverage is limited. Methods: The Mexican Teacher's Cohort (MTC) was established in 2006-2008 when 115,314 female teachers residing in a 12-state area in Mexico (cancer registry coverage, 13%) responded to a questionnaire on reproductive, lifestyle factors, and medical conditions. We projected 955 BC incident cases by the end of 2019. Study participants reported new BC diagnoses in follow-up questionnaires between 2008 and 2020. Self-reports were confirmed by directly contacting participants. Administrative (one medical claims database, two reimbursement databases, and electronic medical records from two institutions) and population-based cancer registry data were used to confirm previously self-reported BC and identify additional cases. Two independent national mortality registries were used to identify BC deaths (2006-2018). Results: We have identified 632 self-reported cases and confirmed 300 through participant contact or presence in a database. We additionally identified and confirmed 100 cases from administrative databases, 25 from cancer registries, and 94 from mortality registries. Median age at diagnosis was 49.0 (± SD 6.9), 63.2% (n=538) of the cases were pre-menopausal and 4.8% (n=41) occurred in indigenous women. Thus far, we have identified 89% (n=851) of the projected number of BC cases by the end of 2019 and confirmed 60.8% (n=518). We know the treating hospital for 30.0% (n=255) of the total cases and obtained histopathology reports from 12.0% (n=62) of the confirmed cases. Conclusion: Leveraging administrative databases for confirmation and identification of incident BC cases is feasible in the MTC. Low- and middle-income countries with limited cancer registry coverage seeking to develop prospective cancer cohorts should explore the use of administrative databases to confirm and identify incident cancer cases. Citation Format: Liliana Gómez-Flores-Ramos, Marion Brochier, Adrian Cortés-Valencia, Susana Lozano-Esparza, Aura Erazo Valle Solís, Aureliano Plácido Méndez, Olga Rosalinda Rivera Ontiveros, Alberto Cundapí Núñez, Angélica Pon Méndez, Martín Lajous. Confirmation and Identification of Incident Cases of Breast Cancer in a Setting with Limited Cancer Registry Coverage: The Mexican Teachers' Cohort [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 82.

English

BACKGROUND Sodium is the most common electrolyte that gets imbalanced in hospitalised patients. Serum sodium abnormalities carry unacceptably high mortality. Our main objective was to study sodium homeostasis in critically ill patients and to correlate sodium imbalances with mortality in critically ill patients. METHODS This was a hospital based retrospective study conducted in Medicine Intensive Care Unit in Assam Medical College and Hospital in Dibrugarh, Assam, India, over a period of one year i.e., from February 2019 to January 2020. Hyponatremia has been defined as sodium level &lt; 135mmol / L and hypernatremia as &gt; 145mmol/L. All patients admitted in MICU of 12 years of age or more have been included in this study. Investigations such as serum creatinine, BUN, sodium, serum osmolality, urine sodium, and urine osmolality as well as neuroimaging were done. A total of 410 patients were studied. RESULTS Out of 410 patients, 106 (25.8 %) had hypernatremia, 84 (20.48 %) had hyponatremia and 220 (53.65 %) had normal sodium levels. 225 (54.87 %) patients died. There was a statistically significant correlation between sodium imbalance and death (p &lt; 0.05). Mortality in hypernatremia (88.68%) was slightly higher than hyponatremia (79.34 %). It was observed that mortality in hypernatremia (OR = 20.7989, 95% CI: 10.6170 – 40.7454, p &lt; 0.0001) and hyponatremia (OR = 10.2015, 95% CI: 5.6651 – 18.3704, p &lt; 0.0001) were higher than that of normonatremia. Percentage of death was more in hypernatremia (88.68%) than hyponatremia (79.34%), but the difference was not statistically significant. (OR = 2.0388, 95% CI = 0.9302 to 4.4687, p = 0.0752). CONCLUSIONS Hyponatremia and hypernatremia are independent mortality factors in critically ill patients. Hypernatremia was more prevalent than hyponatremia in our study and accounted for more number of deaths. Timely and effective correction of sodium levels is important to save a patient’s life. Hypernatremia is often iatrogenic. Therefore proper monitoring of sodium is a must. KEYWORDS Sodium, Homeostasis, Mortality, Hyponatremia, Hypernatremia

Bubbling and hydra effect in a population system with Allee effect

We present a continuous time predator-prey model and predator’s growth subjected to component Allee effect. The model also includes density dependent mortality of predator. We investigate our model both analytically and numerically, and highlighted the effect of density independent mortality and Allee effect. In our system, we find that a fixed point representing the extinction of predator is always a stable point. When coexistence equilibria exists our system is bistable. We have observed that tristability is possible for our model that includes two stable co-existence fixed point. The most important phenomena which we have observed are hydra effect and cascading effect. Due to component Allee effect in predator the system shows multiple hydra effect. We discuss the phenomenon of bubbling, which indicates increasing and decreasing of amplitudes of cycles. We have presented one-parametric as well as two-parametric bifurcation diagram and also all possible bifurcations that the system could go through.

FC 026COVID-19 IMPACT ON ELDERLY HEMODIALYSIS POPULATION: RESULTS FROM THE SPANISH COVID-19 CKD WORKING GROUP REGISTRY

Background and AimsAge and chronic kidney disease have been described as mortality risk factors for coronavirus disease 2019 (COVID-19). Currently, an important percentage of patients in hemodialysis are elderly. This study aimed to investigate the impact of COVID-19 in this population and to determine risk factors associated with mortality.MethodData was obtained from the Spanish COVID-19 CKD Working Group Registry, that included patients in renal replacement therapy (dialysis and kidney transplantation) infected by COVID-19. From March 18, 2020, to August 27, 2020, 1165 patients on hemodialysis affected by COVID-19 were included in the Registry. A total of 328 patients were under 65 years-old and 837 were 65 years old or older (elderly group).ResultsMortality was 18.6% higher (95% confidence interval (CI): 13.8%-23.4%) in the elderly hemodialysis patients compared to the non-elderly group (see figure). Death from COVID-19 infection was increased 5.5-fold in hemodialysis patients compared to mortality in the general population for a similar period, and there was an age-associated mortality increase in both populations (see figure 1). In multivariate Cox regression analysis, age (hazard ratio (HR) 1.58, 95% CI: 1.31-1.92), dyspnea at presentation (HR 1.61, 95% CI: 1.20-2.16), pneumonia (HR 1.76, 95% CI: 1.12-2.75) and admission to hospital (HR 4.13, 95% CI: 1.92-8.88) were identified as independent mortality risk factors in the elderly hemodialysis population. Treatment with glucocorticoids reduced the risk of death (HR 0.71, 95% CI: 0.51-0.98) in aged patients on hemodialysis.FC026 Figure: Mortality in hemodialysis elderly patients. A Survival curves in the hemodialysis population affected by COVID-19 based on age group (elderly and non-elderly). B COVID-19 mortality by age range in the hemodialysis population compared to mortality in the general population for a similar period.ConclusionMortality is dramatically increased in elderly hemodialysis patients affected by COVID-19. Age, dyspnea at presentation, pneumonia or hospitalization are factors associated with a worse prognosis, after adjusting dialysis population to other confounding factors. Treatment with glucocorticoids could be a therapeutic option for this specific population.

MO823EARLY MORTALITY IN INCIDENT HEMODIALYSIS PATIENTS

Abstract Background and Aims Chronic kidney disease (CKD) is known to have significant morbi-mortality worldwide. Patients with CKD and in particular those with ESRD normally carry a large burden of comorbidities and the beginning of hemodialysis leads to a higher risk of decompensation. In fact, annual mortality rates among hemodialysis patients is 10 to 30 times higher than those of the general population. Various studies have demonstrated that incident patients experience the higher mortality rate within the first 3 to 4 months of dialysis. Predicting early mortality is important to help the decision of initiating hemodialysis versus conservative care. Therefore we conducted a case control study to evaluate early mortality predictors in incident hemodialysis patients in our hemodialysis center. Method This is a retrospective case–control study, which to evaluate early mortality predictors in incident hemodialysis patients from January 2013 to December 2018. Descriptive statistics were calculated and expressed as mean (±standard deviation [SD]) or median (intraquartile range [IQR]) for parametric and non-parametric continuous variables and count (%) for categorical variables, respectively. We compared variables between survivors and non-survivors at 3 months after initiation of hemodialysis by using Student’s t-test, Mann-Whitney U test, or Fisher’s exact test where appropriate. Multivariate logistic regression was used to calculate the adjusted odds ratio (OR) with 95% confidence intervals (CI) for the variables associated with early mortality. Results From a total of 559 incident hemodialysis patients, 43 cases were identified (7.7%), and three controls were obtained for each case. From the 172 pts in the study mean (SD) age was 72.4 years (±14), 58.1% were male, and the most common etiologies of CKD were unknown etiology (22.1%, n=38) and diabetic nephropathy (16.9%, n=29). 34.4% (n=59) were dependent of assistance in daily living activities, median (IQR) Charlson Comorbidity Index was 8 (6.10). The non survivors compared to the survivors were older (78.8 ± 9.2 vs 70.3 ± 14.7, p &amp;lt; 0,001), had more AKI or acute-on-chronic CKD (18 (41.9%) vs 18 (14%), p &amp;lt;0,001), emergency start of hemodialysis (29 (67.4%) vs 48 (37.2%), p= 0.001), more catheter use as vascular access (38 (88.4%) vs 92 (71.3%), p=0.024), congestive heart failure (30 (69.8%) vs 32 (24.8%), p &amp;lt; 0.001), ischemic cardiomyopathy (20 (46.5%) vs 30 (23.3%), p=0.004), COPD (13 (30.2%) vs 11 (8.5%), p&amp;lt;0.001), peripheral vascular disease (14 (32.6%) vs 20 (15.5%), p=0.015), Charlson comorbidity index (10 (8-11) vs 7 (6-9), p&amp;lt;0.001), dependence of assistance in daily living activities (22 (51.2%) vs 37 (28.7%), presence of nephrology appointments for &amp;gt;3 months before ESRD (23 (53.5%) vs 102 (79.1%), p=0.01), eGFR (12.3 (6.1) vs 9.1 (4.2), p&amp;lt;0.001), serum albumin (3.1 (2.9-3.5) vs 3.5 (3-3.8), p=0.002). A multivariable analysis was performed and the most suitable model to predict early mortality was age (p=0.003, OR 1.07, 95% C.I. 1.023-1.121), emergency start of hemodialysis (p&amp;lt;0.001, OR 8.35, 95% CI 3.385-20.606), congestive heart failure (p=0.004, OR 3.65, 95% CI 1.519-8.776), peripheral vascular disease (p=0.035, OR 2.97, 95% CI 1.081-8.134). Hosmer-Lemeshow goodness-of-fit performed well (X2 6.67 DF 8; p =0.57), Nagelkerke R2 0.46; AUROC (95% CI) 0.86 (0.80-0.92). Conclusion The percentage of early mortality in our population (7.7%) was compatible with national and European rates. Our model identifies as independent mortality predictors age, emergency start of hemodialysis, congestive heart failure and peripheral vascular disease with an AUROC 0,86. This could help identify patients that could benefit from a more conservative care.

Serum Uric Acid Revealed a U-Shaped Relationship With All-Cause Mortality and Cardiovascular Mortality in High Atherosclerosis Risk Patients: The ASSURE Study.

Background: Previous studies have demonstrated an association between hyperuricemia and cardiovascular disease (CVD). The Framingham study confirmed that patients with high atherosclerotic risks (HARs) had worse prognoses. However, after adjusting for confounding factors, the association between serum uric acid (SUA) and all-cause mortality and cardiovascular mortality remains unclear, especially for HAR patients.Objective: The aim of this study was to reveal the relationship of SUA with all-cause and cardiovascular mortality in HAR patients.Methods: This multicenter cohort study enrolled 3,047 participants, and the follow-up was 68.85 ± 11.37 months. Factors related to cardiovascular and all-cause mortality were tested by multivariate Cox regression analysis. Restricted cubic splines (RCSs) with knots were used to explore the shape of the dose–response relationship with SUA and the hazard ratio (HR) of all-cause and CVD mortality. SUA transformed by RCS was added to the Cox regression model as an independent variable, and all-cause and CVD mortality scores were calculated. Survival receiver operating characteristic curves were produced using a regression model predicting the score.Results: SUA demonstrated a “U-shaped” relationship with all-cause and cardiovascular mortality. SUA predicted all-cause and CVD mortality, with cutoff values of values of >370.5 μmol/L for males and >327.65 μmol/L for females and <180.5 μmol/L for males and <165.7 μmol/L for females, respectively. The survival ROC curve indicated that SUA is able to predict all-cause and CVD mortality, with areas under the curve of 0.702 and 0.711, respectively. The HRs of all-cause mortality (male and female) with hyperuricemia and hypouricemia were 2.08 and 2.01 and 2.04 and 1.98, respectively, and the HRs of CVD mortality (male and female) were 2.09 and 1.79, and 2.02 and 1.89, respectively.Conclusion: Abnormal SUA levels were significant and independent risk factors for all-cause and CVD mortality. Hyperuricemia and hypouricemia increased mortality in both males and females. Routine SUA evaluation and intensive management are needed for HAR patients.Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03616769.

Risk Factors for Mortality in Neonatal Gastric Perforation: A Retrospective Cohort Study.

Background: Neonatal gastric perforation is a rare but life-threatening issue. The aim of this study was to describe the clinical characteristics and prognosis of patients with neonatal gastric perforation and identify predictive factors for poor prognosis.Methods: This was a retrospective cohort study of patients with neonatal gastric perforation treated in a tertiary pediatric public hospital between April 2009 and October 2020. The enrolled patients were divided into survival and non-survival groups. Demographic information, clinical characteristics, laboratory and imaging features, and outcomes were collected from the electronic medical record. Univariate and multivariate logistic regression analyses were performed to obtain the independent factors associated with death risk. Additionally, we separated this population into two groups (pre-term and term groups) and explored the mortality predictors of these two groups, respectively.Results: A total of 101 patients with neonatal gastric perforation were included in this study. The overall survival rate was 70.3%. Seventy-one (70.3%) were pre-term neonates, and sixty-two (61.4%) were low-birth-weight neonates. The median age of onset was 3 days (range: 1–11 days). Abdominal distension [98 (97.0%) patients] was the most common symptom, followed by lethargy [78 (77.2%) patients], shortness of breath [60 (59.4%) patients] and vomiting [34 (33.7%) patients]. Three independent mortality risk factors were identified: shock (OR, 3.749; 95% CI, 1.247–11.269; p = 0.019), serum lactic acid > 2.5 mmol/L (5.346; 1.727–16.547; p = 0.004) and platelet count <150 × 109/L (3.510; 1.115–11.053; p = 0.032). There was a borderline significant association between sclerema neonatorum and total mortality (4.827; 0.889–26.220; p = 0.068). In pre-term infants, serum lactic acid > 2.5 mmol/L and platelet count <150 × 109/L remained independent risk factors for death. In term infants, the incidence of shock, coagulopathy, pH < 7.3, serum lactic acid > 2.5 mmol/L, and hyponatremia were statistically different between non-survival and survival groups.Conclusion: Shock, hyperlactatemia, and thrombocytopenia are independently associated with an increased risk of death in patients with neonatal gastric perforation. Identification of modifiable risk factors during the critical periods of life will contribute to the development of effective prevention and intervention strategies of neonatal gastric perforation.

Platelet count patterns and patient outcomes in sepsis at a tertiary care center: Beyond the APACHE score.

Acute physiology and chronic health evaluation II (APACHE-II) scoring system is used to classify disease severity of patients in the intensive care unit. However, several limitations render the scoring system inadequate in identifying risk factors associated with outcomes. Little is known about the association of platelet count patterns, and the timing of platelet count and other hematologic parameters in predicting mortality in patients with sepsis.This retrospective observational study included 205 septic shock patients, with an overall mortality of 47.8%, enrolled at a tertiary care hospital in Riyadh, Kingdom of Saudi Arabia between 2018 and 2020. Bivariate and multivariate regression analyses were used to identify hematologic risk factors associated with mortality. We used the bivariate Pearson Correlation test to determine correlations between the tested variables and APACHE-II score.Two platelet count patterns emerged: patients with a decline in platelet count after admission (group A pattern, 93.7%) and those with their lowest platelet count at admission (group B pattern, 6.3%). The lowest mean platelet count was significantly lower in nonsurvivors (105.62 ± 10.67 × 103/μL) than in survivors (185.52 ± 10.81 × 103/μL), P < .001. Bivariate Pearson correlation revealed that the lowest platelet count and platelet count decline were significantly correlated with APACHE-II score (r = −0.250, P < .01), (r = 0.326, P < .001), respectively. In multiple logistic regression analysis, the independent mortality risk factors were degree of platelet count decline in group A (odds ratio, 1.028 [95% confidence interval: 1.012–1.045], P = .001) and platelet pattern in group B (odds ratio, 6.901 [95% confidence interval: 1.446–32.932], P = .015). The patterns, values, subsets, and ratios of white blood cell count were not significantly associated with mortality.Nadir platelet count and timing, and degree of platelet count decline are useful markers to predict mortality in early septic shock. Therefore, platelet count patterns might enhance the performance of severity scoring systems in the intensive care unit.