Independent Predictor Of Mortality Research Articles

Expiratory Venous Volume and Arterial Tortuosity are Associated with Disease Severity and Mortality Risk in Patients with COPD: Results from COSYCONET.

The aim of this study was to evaluate the association between computed tomography (CT) quantitative pulmonary vessel morphology and lung function, disease severity, and mortality risk in patients with chronic obstructive pulmonary disease (COPD). Participants of the prospective nationwide COSYCONET cohort study with paired inspiratory-expiratory CT were included. Fully automatic software, developed in-house, segmented arterial and venous pulmonary vessels and quantified volume and tortuosity on inspiratory and expiratory scans. The association between vessel volume normalised to lung volume and tortuosity versus lung function (forced expiratory volume in 1 sec [FEV1]), air trapping (residual volume to total lung capacity ratio [RV/TLC]), transfer factor for carbon monoxide (TLCO), disease severity in terms of Global Initiative for Chronic Obstructive Lung Disease (GOLD) group D, and mortality were analysed by linear, logistic or Cox proportional hazard regression. Complete data were available from 138 patients (39% female, mean age 65 years). FEV1, RV/TLC and TLCO, all as % predicted, were significantly (p < 0.05 each) associated with expiratory vessel characteristics, predominantly venous volume and arterial tortuosity. Associations with inspiratory vessel characteristics were absent or negligible. The patterns were similar for relationships between GOLD D and mortality with vessel characteristics. Expiratory venous volume was an independent predictor of mortality, in addition to FEV1. By using automated software in patients with COPD, clinically relevant information on pulmonary vasculature can be extracted from expiratory CT scans (although not inspiratory scans); in particular, expiratory pulmonary venous volume predicted mortality. NCT01245933.

Utilizing the Frailty Index to Predict Long-term Mortality in Patients Undergoing Major Lower Extremity Amputation

The 5-factor modified Frailty Index (mFI-5) is a risk-stratification tool utilized to predict complications and mortality following major lower extremity (LE) amputation. However, its prognostic value for long-term mortality is unknown. The study aim was to assess whether a high mFI-5 score relates to long-term mortality following major LE amputation for chronic wounds. Patients ≥60 years who underwent major LE amputation from 2017 to 2021 were retrospectively reviewed. Data regarding demographics, comorbidities, perioperative factors, amputation type, and postoperative complications was collected and mFI-5 was calculated. Survival analysis was performed with Kaplan-Meier curves and differences were assessed with Log-Rank test. A total of 172 patients were identified. Mean age was 70.7 ± 8.0 years. Median time to ambulation was 3.7 months (IQR 4.0). By final follow-up of 17.5 ± 15.9 months, ambulatory rate was 51.7% (n=89), overall mortality 36.0% (n=62), one-year mortality 14.0% (n=24), and three-year mortality 27.9% (n=48). Patients with an mFI-5 of ≥4 (26.7%, n=46) compared with patients with mFI-5 <4 (73.3%, n=126) had a higher rate of prolonged postoperative LOS (34.8% vs. 19.8%, p=0.042), overall mortality (52.2% vs. 30.2%, p=0.008), one-year mortality (23.9% vs. 10.3%, p=0.023), and three-year mortality (45.7% vs. 21.4%, p=0.002). Multivariate analysis demonstrated mFI-5 was an independent predictor of three-year mortality (OR 2.35, p=0.043). At a threshold ≥4, the mFI-5 demonstrated utility in predicting long-term mortality. The value of this prognostic indicator is in its preoperative application of assessing risk of mortality, which should be utilized in conjunction with other measures.

Predictive value of the dynamics of absolute lymphocyte counts for 90-day mortality in ICU sepsis patients: a retrospective big data study

ObjectivesThe objective of the study was to assess the clinical predictive value of the dynamics of absolute lymphocyte count (ALC) for 90-day all-cause mortality in sepsis patients in intensive care...

Predictors of In-Hospital Mortality in Type A Acute Aortic Syndrome: Data From the RENADA-RO Registry

This study aimed to analyse the baseline characteristics of patients admitted with acute type A aortic syndrome (ATAAS) and to identify the potential predictors of in-hospital mortality in surgically managed patients. Data regarding demographics, clinical presentation, laboratory work-up, and management of 501 patients with ATAAS enrolled in the National Registry of Aortic Dissections-Romania registry from January 2011 to December 2022 were evaluated. The primary endpoint was in-hospital all-cause mortality. Multivariate logistic regression was conducted to identify independent predictors of mortality in patients with acute Type A aortic dissection (ATAAD) who underwent surgery. The mean age was 60±11 years and 65% were male. Computed tomography was the first-line diagnostic tool (79%), followed by transoesophageal echocardiography (21%). Cardiac surgery was performed in 88% of the patients. The overall mortality in the entire cohort was 37.9%, while surgically managed ATAAD patients had an in-hospital mortality rate of 29%. In multivariate logistic regression, creatinine value (OR 6.76), ST depression on ECG (OR 6.3), preoperative malperfusion (OR 5.77), cardiogenic shock (OR 5.77), abdominal pain (OR 4.27), age ≥70 years (OR 3.76), and syncope (OR 3.43) were independently associated with in-hospital mortality in surgically managed ATAAD patients. Risk stratification based on the variables collected at admission may help to identify ATAAS patients with high risk of death following cardiac surgery.

Predictive value of the controlling nutritional status (CONUT) score to assess long-term mortality (10 Years) in patients with hypertension

Background and aimsMalnutrition is associated with poor outcomes in patients with chronic diseases. Aim of this study is to investigate the prevalence of malnutrition in patients with hypertension and relationship between malnutrition severity and long-term mortality in these patients. Methods and resultThe study included 11,278 patients with hypertension from the National Health and Nutrition Examination Survey database. The degree of malnutrition was assessed using the Controlled Nutritional Status score, with patients divided into normal, mild, and moderate-to-severe groups. After 10 years of follow-up, the results showed that patients who died had higher CONUT scores, poorer nutritional status, and lower albumin, total cholesterol, and lymphocyte counts than those who survived (P < 0.05). The Kaplan–Meier analysis revealed that patients with poor nutritional status had a significantly higher risk of all-cause death. In the Non-Lipid Lowering Drugs group, the CONUT score (hazard ratio (HR): 1.225; 95% confidence interval (CI): 1.162–1.292; P < 0.0001), as well as mild (HR: 1.532; 95% CI 1.340–1.751; P < 0.0001) and moderate-to-severe malnutrition (HR: 2.797; 95% CI: 1.441–5.428; P = 0.0024), were independent predictors of long-term mortality. The competing risk regression models showed that cardiovascular and cerebrovascular mortality increased with increasing CONUT scores. The results were robust in both subgroup and sensitivity analyses. ConclusionMalnutrition significantly impacts long-term mortality in hypertensive patients. The CONUT score may be a useful tool for assessing the nutritional status of patients with hypertension in the non-lipid-lowering population and for predicting their long-term mortality.

Radiomics based on HRCT can predict RP-ILD and mortality in anti-MDA5 + dermatomyositis patients: a multi-center retrospective study

ObjectivesTo assess the effectiveness of HRCT-based radiomics in predicting rapidly progressive interstitial lung disease (RP-ILD) and mortality in anti-MDA5 positive dermatomyositis-related interstitial lung disease (anti-MDA5 + DM-ILD).MethodsFrom August 2014 to March 2022, 160 patients from Institution 1 were retrospectively and consecutively enrolled and were randomly divided into the training dataset (n = 119) and internal validation dataset (n = 41), while 29 patients from Institution 2 were retrospectively and consecutively enrolled as external validation dataset. We generated four Risk-scores based on radiomics features extracted from four areas of HRCT. A nomogram was established by integrating the selected clinico-radiologic variables and the Risk-score of the most discriminative radiomics model. The RP-ILD prediction performance of the models was evaluated by using the area under the receiver operating characteristic curves, calibration curves, and decision curves. Survival analysis was conducted with Kaplan-Meier curves, Mantel-Haenszel test, and Cox regression.ResultsOver a median follow-up time of 31.6 months (interquartile range: 12.9–49.1 months), 24 patients lost to follow-up and 46 patients lost their lives (27.9%, 46/165). The Risk-score based on bilateral lungs performed best, attaining AUCs of 0.869 and 0.905 in the internal and external validation datasets. The nomogram outperformed clinico-radiologic model and Risk-score with AUCs of 0.882 and 0.916 in the internal and external validation datasets. Patients were classified into low- and high-risk groups with 50:50 based on nomogram. High-risk group patients demonstrated a significantly higher risk of mortality than low-risk group patients in institution 1 (HR = 4.117) and institution 2 cohorts (HR = 7.515).ConclusionFor anti-MDA5 + DM-ILD, the nomogram, mainly based on radiomics, can predict RP-ILD and is an independent predictor of mortality.

Comparative analysis of prognostic scoring systems in predicting severity and outcomes of Omicron variant COVID-19 pneumonia.

The global spread of Coronavirus Disease 2019 (COVID-19) underscores the urgent need for reliable methods to forecast the disease's severity and outcome, thereby facilitating timely interventions and reducing mortality rates. This study focuses on evaluating the clinical and laboratory profiles of patients with Omicron variant-induced COVID-19 pneumonia and assessing the efficacy of various scoring systems in prognosticating disease severity and mortality. In this retrospective analysis, we examined the clinical records of 409 individuals diagnosed with Omicron variant COVID-19 pneumonia. We documented the Pneumonia Severity Index, CURB-65, and MuLBSTA scores within the first 24 h and analyzed the sensitivity, specificity, positive predictive value, negative predictive value, and the area under the receiver operating characteristic curve for each scoring system to ascertain their predictive accuracy for disease severity and fatality risk. The cohort's median age was 78 years, predominantly presenting with fever, cough, expectoration, fatigue, and gastrointestinal symptoms. Factors such as expectoration, fatigue, Glasgow Coma Scale score, lactate dehydrogenase levels, procalcitonin, creatinine levels, and co-occurrence of acute respiratory distress syndrome were identified as independent predictors of disease severity. Furthermore, age, oxygenation index, glucose levels, lactate dehydrogenase, and septic shock were independently associated with mortality. For severe disease prediction, the CURB-65, PSI, and MuLBSTA scores demonstrated sensitivities of 65.9%, 63.8%, and 79.7%, respectively, with specificities of 63.8%, 76.8%, and 60.9%, and AUROCs of 0.707, 0.750, and 0.728. To predict mortality risk, these scores at cutoffs of 1.5, 102.5, and 12.5 exhibited sensitivities of 83.3%, 96.3%, and 70.4%, specificities of 59.4%, 60.8%, and 65.4%, and AUROCs of 0.787, 0.850, and 0.736, respectively. The study cohort predominantly comprised elderly individuals with pre-existing health conditions. Elevated lactate dehydrogenase emerged as a significant marker for both disease severity and prognosis, sputum production, gastrointestinal symptoms, GCS score, creatinine, PCT, and ARDS as independent predictors of disease severity, and age, oxygenation index, glucose levels, and septic shock as independent mortality predictors in COVID-19 pneumonia patients. Among the scoring systems evaluated, Pneumonia Severity Index demonstrated superior predictive capability for both disease severity and mortality, suggesting its utility in forecasting the clinical outcomes of Omicron variant COVID-19 pneumonia.

Estimated Pulse Wave Velocity and All-Cause and Cardiovascular Mortality in the General Population.

Background: Carotid-femoral pulse wave velocity (cfPWV), acknowledged as a reliable proxy of arterial stiffness, is an independent predictor of cardiovascular (CV) events. Carotid-femoral PWV is considered the gold standard for the estimation of arterial stiffness. cfPWV is a demanding, time consuming and expensive method, and an estimated PWV (ePWV) has been suggested as an alternative method when cfPWV is not available. Our aim was to analyze the predictive role of ePWV for CV and all-cause mortality in the general population. Methods: In a stratified random sample of 1086 subjects from the general Croatian adult population (EH-UH study) (men 42.4%, average age 53 ± 16), subjects were followed for 17 years. ePWV was calculated using the following formula: ePWV = 9.587 - 0.402 × age + 4.560 × 10-3 × age2 - 2.621 × 10-5 × age2 × MBP + 3.176 × 10-3 × age × MBP - 1.832 × 10-2 × MBP. MBP= (DBP) + 0.4(SBP - DBP). Results: At the end of the follow-up period, there were 228 deaths (CV, stroke, cancer, dementia and degenerative diseases, COLD, and others 43.4%, 10.5%, 28.5%, 5.2%, 3.1%, 9.3%, respectively). In the third ePWV tercile, we observed more deaths due to CV disease than to cancer (20.5% vs. 51.04%). In a Cox regression analysis, for each increase in ePWV of 1 m/s, there was a 14% increase risk for CV death. In the subgroup of subjects with higher CV risk, we found ePWV to be a significant predictor of CV deaths (ePWV (m/s) CI 1.108; p < 0.029; HR 3.03, 95% CI 1.118-8.211). Conclusions: In subjects with high CV risk, ePWV was a significant and independent predictor of CV mortality.

Nationwide Analysis of Adult-Onset Still Disease With and Without Hemophagocytic Lymphohistiocytosis.

Adult-onset Still disease (AOSD) is a rare inflammatory condition with a monophasic, intermittent, or chronic clinical course, and a subset may experience life-threatening complications such as hemophagocytic lymphohistiocytosis (HLH). This study aims to characterize concurrent AOSD and HLH and identify variables independently associated with in-hospital death. We performed a medical records review of AOSD with and without HLH from the 2016-2019 National Inpatient Sample database. We performed a multivariable logistic regression analysis for in-hospital death. Results were reported as adjusted odds ratios (ORadj). There were 5495 hospitalizations with AOSD, of which 340 (6.2%) had HLH. Thirty (9.0%) of the combined AOSD and HLH group died in the hospital compared with 75 (1.5%) of those without HLH. Multivariable analysis in AOSD inpatients showed that disseminated intravascular coagulation (ORadj 6.13), hepatic failure (ORadj 7.16), infection (ORadj 3.72), respiratory failure (ORadj 6.89), and thrombotic microangiopathy (ORadj 14.05) were associated with higher odds of death. However, HLH itself was not an independent predictor of mortality in AOSD population. HLH occurred in a small minority of inpatients with AOSD. HLH itself was not an independent risk factor for in-hospital death. Disseminated intravascular coagulation, hepatic failure, infection, respiratory failure, and thrombotic microangiopathy were associated with higher odds of in-hospital death in AOSD. Better awareness of these life-threatening complications may improve hospital outcomes.

Prognosis and Treatment Strategies for Atrial Fibrillation in Heart Failure with Mildly Reduced Ejection Fraction.

The study investigates the prognosis of atrial fibrillation (AF) in patients with heart failure with mildly reduced ejection fraction (HFmrEF). Data concerning the prognostic impact of AF in patients with HFmrEF is scarce. Consecutive patients with HFmrEF (i.e., left ventricular ejection fraction 41-49% and signs and/or symptoms of HF) were retrospectively included at one institution from 2016 to 2022. Patients with AF were compared to patients without with regard to the primary composite endpoint of all-cause mortality and HF-related rehospitalization at 30 months (median follow-up). Statistical analyses included Kaplan-Meier analyses, multivariable Cox proportional regression analyses and propensity score matching. 2,148 patients with HFmrEF were included with an overall prevalence of AF of 43%. The presence of AF was associated with higher risk of the primary composite endpoint all-cause mortality and HF-related rehospitalization at 30 months (HR = 2.068; 95% CI 1.802-2.375; p = 0.01), which was confirmed after propensity-score matching (HR = 1.494; 95% CI 1.216-1.835; p = 0.01). AF was an independent predictor of both all-cause mortality (HR = 1.340; 95% CI 1.066-1.685; p = 0.01) and HF-related rehospitalization (HR = 2.061; 95% CI 1.538-2.696; p = 0.01). Finally, rhythm control may be associated with lower risk of all-cause mortality compared to rate control for AF (HR = 0.342; 95% CI 0.199-0.587; p = 0.01). AF affects 43% of patients with HFmrEF and represents an independent predictor of adverse long-term prognosis.

Effect of heart failure on mortality and clinical outcomes in patients hospitalized with pancreatic cancer.

e16367 Background: Pancreatic cancer (PC) is the fourth leading cause of cancer-related death globally. The impact of HF on clinical outcomes in hospitalized patients with PC remains unknown. Considering the poor prognosis associated with PC, we aim to compare clinical outcomes in PC patients with or without HF. Methods: The research utilized the National Inpatient Sample (NIS) database, covering data from 2019 and 2020. Through this dataset, patients hospitalized with a primary discharge diagnosis of PC and a concurrent secondary diagnosis of HF were identified and a multivariate regression analysis was applied. Our primary outcome was mortality in patients with comorbid heart failure in patients diagnosed with pancreatic cancer compared to pancreatic cancer alone and our secondary outcomes were the length of hospitalization, associated hospitalization cost, and the risk of clinical complications or outcomes such as major depressive disorder, atrial fibrillation, acute coronary syndrome, etc. Baseline patient characteristics were found to be comparable in either group and data hence was not specifically adjusted in this regard. Results: A total of 74,585 patients were hospitalized with PC, of which 5,755 had a concurrent diagnosis of HF. The mean age of patients with HF was 74.43 years, while those without heart failure was 67.97 years. Primary and secondary outcomes were calculated. HF was not found to be an independent predictor of mortality (OR 1.17, 95% CI 0.90-1.53, p=0.22), and there was no significant difference in the length of stay in the hospital between the two groups of patients (1.09, 95% CI 0.59-1.60, p&lt;0.001). However, patients with heart failure had an increased total cost of hospitalization ($18,045, 95% CI 5,697-30,392, p=0.00) and increased odds of worse clinical outcomes such as major depressive disorder (OR 1.26, 95% CI 1.02-1.55, p=0.03), p&lt;0.001), atrial fibrillation (OR 4.59, 95% CI 3.85-5.47), acute coronary syndrome (OR 9.96, 95% CI 4.31-23.01, p&lt;0.001), acute respiratory failure (OR 2.69, 95% CI 2.08-3.47, pneumonia (OR 1.66, 95% CI 1.17-2.36 p=0.00), septic shock (OR 1.54, 95% CI 1.09-2.17, p=0.01), p&lt;0.001), invasive mechanical ventilation (OR 2.70, 95% CI 1.96-3.72, p&lt;0.001), ICU admission (OR 2.18, 95% CI 1.67-2.85, p&lt;0.001), acute kidney injury (OR 1.84, 95% CI 1.56-2.18, p&lt;0.001), and cardiovascular accident (CVA) (OR 2.74, 95% CI 1.37-5.47, p=0.004). Conclusions: HF is not an independent predictor of mortality or prolonged length in PC patients, but it is associated with increased hospitalization costs and adverse clinical outcomes. Implementing careful and aggressive management strategies for addressing HF is necessary to optimize patient quality of life, minimize adverse events, and reduce resource utilization to minimize the costs of hospitalization and improve quality of life.

Understanding the relationship between obesity and in-hospital outcomes in gastric cancer patients : A nationwide analysis.

e16050 Background: Gastric cancer is the fifth most common form of cancer and the third leading cause of cancer-related deaths worldwide. Obesity has been identified as a significant risk factor for gastric cancer, associated with increased incidence and heightened complications in hospitalized patients. Our analysis comprehensively evaluates obesity's impact on hospital-admitted gastric cancer patients. Methods: Using the National Inpatient Sample (NIS) 2020, we identified gastric cancer patients with regional and advanced metastatic disease, and they were stratified into patients with and without obesity. The primary outcome was mortality, and secondary outcomes included length of stay, the total cost of hospitalization, and other in-hospital adverse outcomes. Multivariate logistic regression analysis was used to calculate the outcomes after adjusting for confounding variables. Results: A total of 17560 patients were hospitalized with gastric cancer, among which 1720(9.8%) had the concurrent diagnosis of Obesity. The mean age of patients with and without Obesity was 63 (+/- 13.88) and 66 (+/- 12.93),p&lt;0.001 respectively. The obese category had the greater percentage of male patients as compared to females (58.14% vs 44.85% respectively, p&lt;0.001). After adjusting for confounding variables, Obesity was not considered as an independent predictor of mortality in patients with gastric cancer (OR=1.06(0.59-1.92); p=0.90). However, patients with Obesity had prolonged length of stay (+ 1.52 days(1.49-2.26); p=0.004) and total cost of hospitalization (+ $30977(12320-49633); p=0.001). Similarly, obese patients had an increased likelihood of Acute kidney injury (OR=1.47(1.09-1.96); p=0.01), ICU admission (OR=2.01(1.30-3.09); p=0.002), invasive (OR=2.14(1.29-3.54); p=0.003) Noninvasive mechanical ventilation (OR=5.36(2.17-13.14); p&lt;0.001) and Heart failure (OR=1.68(1.09-2.57); p=0.02). No difference was noted in the risk of cardiac arrest (OR=1.26(0.28-5.68); p=0.76), and sepsis(OR=1.76(0.99-3.13); p=0.05). Conclusions: Obesity in patients with gastric cancer is not an independent predictor of mortality but is associated with increased length of stay, the total cost of hospitalization, increased risk of mechanical ventilation, and ICU admissions. Management of obesity can prove crucial in averting a wide range of potential health complications and significantly enhancing the overall quality of life in gastric cancer patients. [Table: see text]

Impact of delirium on in-patient outcomes in patients with pancreatic cancer: A nationwide study.

e16369 Background: Pancreatic cancer is the fourth leading cause of cancer-related death in the United States. Anecdotal evidence suggests that delirium, characterized by a state of disorientation and confusion, is associated with adverse clinical outcomes, especially in aggressive diseases like cancer. We aim to analyze the impact of delirium on outcomes in patients hospitalized with pancreatic cancer. Methods: The National Inpatient Sample (2017-2020) was employed to identify patients who were admitted with a primary diagnosis of pancreatic cancer. Multivariate regression analysis was employed and the results of this study were reported adhering to the STROBE guidelines. Our primary outcome was inpatient mortality in patients with pancreatic cancer with and without a concurrent diagnosis of delirium. The secondary outcomes included the length of hospital stay, the total cost of hospitalization, and clinical complications or outcomes such as Fluid and Electrolyte Disorders, AKI, Major Depressive Disorder, etc. Baseline characteristics were comparable between patients in either group. Results: A total of 149525 patients had a diagnosis of pancreatic cancer, among which 1850 had concurrent delirium. The mean age of patients with and without delirium was 72.92±SD vs 68.24±SD years, respectively ( p = 0.004). Patients with delirium were found to have higher odds of in-patient mortality (OR = 3.89, 95% CI: 2.78- 5.44 , p &lt; 0.001). Length of stay and total hospitalization cost were also significantly increased in patients with concurrent delirium (+6.69 days, 95% CI 5.32-8.05, P &lt; 0.001 and + USD 104355, 95% CI 71358- 137352 , p &lt; 0.001, respectively). Similarly, pancreatic cancer patients with delirium had increased likelihood of fluid and electrolyte imbalance (OR = 1.51 95% CI 1.19-1.90, p &lt; 0.001), acute kidney injury (OR = 2.31, 95% CI 1.76-3.04, p &lt; 0.001), major depressive disorder (OR = 1.46, 95% CI 1.06-2.01, p = 0.02), anxiety (OR = 2.19, 95% CI 1.67-2.88, p &lt; 0.001), dementia (OR = 5.58, 95% CI 4.10-7.59, p &lt; 0.001), pneumonia (OR = 1.99, 95% CI 1.19-3.33, p = 0.008), sepsis (OR = 3.13, 95% CI 2.13-4.61, p &lt; 0.001), acute respiratory failure (OR = 3.05, 95% CI 2.16-4.31, p &lt; 0.001), ICU admission (OR = 3.31, 95% CI 2.34-4.68, p &lt; 0.001), mechanical ventilation (OR = 3.79, 95% CI 2.57-5.59, p &lt; 0.001), vasopressor use (OR = 2.62, 95% CI 1.34-5.11, p = 0.004), cardiac arrest (OR = 2.50, 95% CI 1.05-6.24 , p = 0.04). Conclusions: Delirium in hospitalized patients with pancreatic cancer results in worse clinical outcomes and is an independent predictor of mortality. It is associated with a four-fold increase in mortality and a significant increase in length of stay, total cost of hospitalization and worse clinical outcomes. Appropriate management of delirium in patients with pancreatic carcinoma is therefore crucial for decreasing morbidity and mortality among these patients.

Assessing the clinical efficacy of low-volume therapeutic plasma exchange in achieving recovery from acute liver failure induced by yellow phosphorous poisoning.

Acute liver failure (ALF) following yellow phosphorous (YP) ingestion is similar to acetaminophen-induced ALF and it has become a public concern in our region. This study assessed low volume therapeutic plasma exchange (LV-TPE) efficacy in improving the transplant free survival in YP poisoning. Adult patients with toxicology reports of YP and ALF requiring critical care were included in the study. LV-TPE was planned for three consecutive days and three more if required. Performed 1.3 to 1.5 plasma volume replacing with 0.9% normal saline, 5% human albumin solution, and fresh frozen plasma based on ASFA 2019 criteria. MELD score, laboratory parameters, LV-TPE details were captured. The study end point was clinical outcome of the patients. Among 36 patients, 19 underwent LV-TPE and 17 opted out of LV-TPE and they were included as a control arm. The MELD score was 32.64 ± 8.05 and 37.83 ± 9.37 in both groups. There were 13 survivors in LV-TPE group leading to a 68.42% reduction in mortality. The coagulation and biochemical parameters showed a significant percentage change after LV-TPE. Refractory shock, delay in initiating procedure and acidosis were independent predictors of mortality. A well-timed LV-TPE improves the survival of patients with ALF due to YP poisoning.

Arterial stiffness and aortic hemodynamics as predictors for new or worsening cardiovascular events in childhood cancer survivors: A report from the St. Jude lifetime cohort.

e24006 Background: Survival following childhood cancer has improved due to advances in treatment and supportive care. However, survivors are at high risk of cardiovascular diseases (CVDs) later in life. Aortic artery stiffening, captured by measuring the speed and magnitude of forward and reflected pulse waves, is an independent predictor of CVD and mortality in the general population. Methods: We evaluated associations between vascular function and new or worsening CVDs [coronary artery disease (CAD), cardiomyopathy, and hypertension (HTN)] among a subset (n = 249) of St. Jude Lifetime Cohort (SJLIFE) participants who had baseline vascular function assessment and returned for a standard follow up study visit (mean age at baseline (years) ± standard deviation: 34 ± 9 years, follow-up: 39 ± 9 years). CVD conditions were graded (dichotomized as grades 0-1 and 2-4) using the Common Terminology Criteria for Adverse Events (CTCAE). Aortic stiffness, brachial and aortic blood pressure (BP), and aortic wave reflection (augmented pressure, augmentation index (AIx), AIx adjusted to a heart rate of 75 beats/min (AIx75), time and magnitude of the forward and reflected waves) were assessed using wave separation analyses. T-tests were used to test mean values between the groups with higher (2-5) and lower (0-1) grades. These tests informed the selection of identified variables for multivariate logistic models, which were adjusted for age, sex, race, body mass index, physical activity, smoking status, drinking behavior and vasoactive medications. Results: Most participants had a history of Hodgkin lymphoma (53.8%) or leukemia (20.5%) and 25.7% other diagnoses. There were 169 (67.9%) participants who had cranial/neck radiation, 167 (67.9%) received anthracyclines, and 150 (60.2%) alkylating agents. At baseline 38.2% had ≥grade 2 HTN, 9.2% cardiomyopathy, and 4% CAD. Having ≥ grade 2 CVDs was significantly associated with augmented markers of brachial and aortic BP, arterial stiffness, and wave reflection. Regression analyses revealed that AIx75 ≥ 17% was associated with an increased risk of new or worsening HTN (odds ratio (OR) 3.29, 95% confidence interval (CI) 1.03-10.48) and new or worsening cardiomyopathy (OR 4.06, 95% CI 1.02-16.16) an average of 5 years after baseline vascular testing. Conclusions: Childhood cancer survivors diagnosed with grades 2-4 CVDs at a baseline visit had elevated aortic stiffness and augmented indices of wave reflection compared to those with &lt; grade 2 CVDs. Elevated AIx75 was associated with new or worsening HTN and cardiomyopathy five years later. Early detection and treatment of vascular dysfunction may ameliorate CVD late effects in childhood cancer survivors.

Impact of cardiac arrhythmias on in-hospital mortality in patients with cytokine release syndrome: Insights from National Inpatient Sample.

e24017 Background: Cytokine release syndrome (CSR) is a pervasive inflammatory response characterized by elevated body temperature and multi-organ dysfunction. This syndrome is linked to chimeric antigen receptor (CAR)-T cell therapy, various immunotherapies, or haploidentical hematopoietic cell transplantation (HCT). It can manifest as a fever, fatigue, headache, rash, diarrhea, arthralgia, and myalgia. In some cases, it can progress to hypotension, hypoxia, and an uncontrolled systemic inflammatory response leading to circulatory collapse, pulmonary edema, renal damage, and multi-organ failure. Cardiac evaluation in the context of CSR is crucial for assessing these manifestations, but little is known about the arrhythmias associated with this therapy, and there is limited information in the literature. Methods: A retrospective study using the National Inpatient Sample to identify patients diagnosed with CRS, and the arrhythmias they experienced during their hospitalizations between January and December 2020. The primary endpoint was the incidence of various arrhythmias. Furthermore, Independent predictors of in-hospital mortality were analyzed, with p values, adjusted odds ratios (aOR) and confidence intervals (CI) calculated for each variable. Results: A total of 4675 patients were diagnosed with CRS in 2020, 39% of whom were females. The mortality rate of patients with CRS was 22%. In addition, the mortality rate of patients who developed arrhythmias was 43% while that of patients who did not was 17% (p &lt; 0.01). The mean age was higher in the arrhythmia cohort compared with the non-arrhythmia cohort (70 vs 60.7 years, p &lt; 0.01). Predictive factors associated with increased mortality included development of arrhythmias, age, hispanic race, asian or pacific islander race, obesity, previous myocardial infarction, and electrolyte abnormalities with an aOR of 2.22 (P &lt; 0.01, CI 1.51-3.28), 1.03 (P &lt; 0.01, CI 1.01-1.05), 1.85 (P = 0.04, CI 1.02-3.34), 2.57 (P = 0.014, CI 1.02-3.34), 1.72 (P = 0.018, CI 1.09-2.69), 3.26 (P = 0.008, CI 1.36-7.8), and 4.19 (P &lt; 0.01, CI 2.7-6.4) respectively. Female sex was found to be protective against mortality with an aOR of 0.5 (P = 0.004, CI 0.31-0.8). Conclusions: Our study reveals that developing arrhythmias is more common in older patients with CRS. Patients diagnosed with arrhythmias during their hospitalization experienced poorer outcomes. Adjusted predictors of mortality include the development of arrhythmias during hospitalization, age, hispanic race, asian or pacific islander race, obesity, previous myocardial infarction, and electrolyte imbalances. Additionally, female sex was found to be a protective against mortality. Given these findings, physicians should strive to be more vigilant when treating patients with CRS who have any of these predictors of mortality until further data is available.

Construction and validation of a nomogram for predicting the prognosis of patients with septic shock in department of emergency medicine

To construct a nomogram model for predicting the 28-day mortality of patients with septic shock in the emergency medicine department and to validate the predictive efficacy. Based on the database of the emergency medicine department of Chu Hsien-I Memorial Hospital of Tianjin Medical University, Tianjin Medical University General Hospital and the Second Hospital of Tianjin Medical University, the data of 913 patients with septic shock admitted to the emergency medicine department from January 2017 to October 2020 were collected, including baseline demographic information and clinical characteristics, laboratory indices, and the main endpoints (28-day mortality). The patients were divided into a training set and a validation set based on simple random sampling. All significant variables from the one-way binary Logistic regression analysis of the training set were included in the multivariate Logistic regression analysis to analyze the risk factors for 28-day mortality in patients with septic shock and to construct a column-line graphical model. The predictive efficacy of the nomogram model was assessed using calibration curves and receiver operator characteristic curve (ROC curve). A total of 860 patients with septic shock meeting the criteria were finally enrolled, including 472 in the training set and 388 in the validation set. The 28-day mortalities were 52.5% (248/472) and 54.1% (210/388) for the training and validation sets, respectively. In the training set, age, respiratory rate (RR), the levels of C-reactive protein (CRP), D-dimer, white blood cell count (WBC), neutrophil count (NEU), neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), mean platelet volume (MPV), and platelet count (PLT) in the death group were significantly higher than those in the survival group, and the levels of base remaining (BE), lymphocyte count (LYM), hemoglobin (Hb) and the proportion of chronic obstructive pulmonary diseases (COPD) were significantly lower than those in the survival group (all P < 0.05). Multifactorial Logistic regression analysis showed that NLR [odds ratio (OR) = 0.023 0, 95% confidence interval (95%CI) was -0.204 4 to 0.113 0], MPV (OR = 0.179 8, 95%CI was -0.877 6 to 0.172 7), Hb (OR = 0.007 8, 95%CI was 0.010 3 to 0.040 8), procalcitonin (PCT; OR = 1.957 0, 95%CI was 1.243 0 to 3.081 0), and D-dimer (OR = 0.000 1, 95%CI was -0.000 4 to 0.000 1) were independent predictors of 28-day mortality in patients with septic shock in the emergency department (all P < 0.05). A column-line graph model was established based on the above variables, and the ROC curves showed that the area under the ROC curve (AUC) of the nomogram model in the training set and validation set for predicting the 28-day mortality of patients with septic shock was 0.907 (95%CI was 0.864 to 0.940) and 0.822 (95%CI was 0.781 to 0.863), respectively. The calibration curves showed good agreement between the predicted and observed results for both the training and validation sets. The nomogram model constructed based on NLR, MPV, Hb, PCT and D-dimer has significant clinical value in predicting the 28-day mortality of patients with septic shock in the emergency medicine department.

CARDIAC ULTRASOUND ALTERATIONS IN INDIVIDUALS WITH PNEUMONIA RELATED TO COVID-19 INFECTION

A wide range of cardiac effects are observed during the acute phase of COVID-19. Interestingly, troponin levels are raised in 8–28% of instances, while systolic myocardial dysfunction symptoms are not always evident. Subclinical myocardial dysfunction is more common and is commonly defined as a decrease in the left ventricle's global longitudinal strain (LV GLS). Up to 80% of individuals exhibit this alteration while they are in the hospital. LV GLS is a crucial component in risk assessment for follow-up care and a strong independent predictor of in-hospital mortality. The first results on the long-term cardiovascular effects of COVID-19 one year after hospitalization are presented in this study. One year after discharge, we found that patients with COVID-19 pneumonia had a negative trend in LV GLS and deformation metrics in the apical and certain middle segments of the LV myocardium, as compared to data collected three months after discharge. The purpose of the study is to look at the prevalence and clinical significance of long-term heart injury following COVID-19. In order to do this, we examined patient data and categorized patients a year following hospital discharge according to their LV GLS values. This method aids in comprehending the clinical ramifications of long-term cardiac injury after COVID-19.

Association of Pan Immune-Inflammation Value with Long Term Outcomes of Acute Decompensated Heart Failure.

Although there have been significant improvements in the treatment of heart failure (HF) in recent decades, its prognosis remains poor. Although there are many biomarkers that can help predict the prognosis of patients with HF, there is a need for simpler, cheaper, and more easily available biomarkers. To evaluate the predictive value of pan-immune-inflammation value (PIV) in patients with acute decompensated HF. We analyzed 409 patients with HF with reduced ejection fraction who were hospitalized for acute decompensated HF. Patients were divided into 3 groups according to tertiles of PIV: tertile 1 (PIV < 357.25), tertile 2 (PIV ≥ 357.25 and < 834.55), and tertile 3 (PIV ≥ 834.55). P values < 0.05 were considered statistically significant. Kaplan-Meier curves and Cox proportional hazards regression models were used to evaluate the association between PIV and all-cause mortality. The primary outcome was 5-year all-cause mortality, and the secondary outcomes were in-hospital 30 days,, 180-day, and 1-year all-cause mortality. We showed that higher PIV value was associated with both primary and secondary outcomes. The Kaplan-Meier curve showed that patients with higher PIV values had an increased risk of short- and long-term all-cause mortality (log-rank p < 0.001). In the multivariate analysis, PIV was identified as an independent predictor of long-term all-cause mortality in patients with acute decompensated HF, and we observed a 1.96-fold increase in the hazard of an event (odds ratio: 1.96, 95% confidence interval: 1.330 to 2.908, p = 0.001). Our study showed that the novel biomarker PIV can be used as a predictor of prognosis in patients with acute decompensated HF.

Predictors of thirty-day mortality among patients with blood stream infection with WHO priority pathogens: single centre exploratory study from a referral teaching hospital in central India.

Bloodstream infection (BSI) is defined by the presence of viable microorganisms in the bloodstream. BSI is one of the major causes of sepsis and subsequent adverse clinical outcomes all across the globe. The present study was undertaken to identify clinico-epidemio-microbiological variables associated with 30-day mortality in patients having BSI with WHO priority pathogens. The study was conducted at a public sector tertiary care institute in central India from April 2019 to March 2021. Blood samples collected from patients with clinical suspicion of sepsis, were processed by automated bacterial culture system and interpreted as per CLSI guidelines. Calculated sample size was 150. Data was analyzed by R software. Respiratory tract infection was the most common source (43.3%) of BSI, followed by the gastrointestinal (20%) and urinary tract (18.7%). Among the patients, 33% required invasive mechanical ventilation, and 31% required inotropes. Diabetes mellitus (DM) was the most common co-morbidity (34%). The incidence of multi-drug resistant organisms (MDRO) was 59.3%. Escherichia coli was the most commonly (24%) isolated organism, followed by Klebsiella pneumoniae (17.3%) and Acinetobacter baumannii (16%). Higher age, higher qSOFA score / SIRS score / mean SOFA score at presentation had higher mortality. Use of mechanical ventilation and inotropes during treatment and isolation of critical category organisms of WPP and multi drug resistant organisms were independent 30-day mortality predictors.