Independent Predictors Of Early Mortality Research Articles

Ischemic stroke subtypes: risk factors, treatments, and 1-month prognosis – The Lille, France Stroke Registry

ObjectivesFirst, this registry-based study aimed to comprehensively analyze patients' medical histories and treatments based on ischemic strokes’ etiology. We focused on the management of atrial fibrillation among patients diagnosed with cardioembolic stroke. Then, our objective was to identify prognostic factors associated with 28-day mortality. Materials and methodsAll ischemic strokes occurring in adults between 2014 and 2021 in Lille, France, were categorized using the TOAST classification. Comparative analyses of patients' medical characteristics were conducted across subtypes. Survival rates within 28 days post-stroke were assessed, and factors influencing mortality were identified using a multivariate Cox model. Results1912 ischemic strokes were recorded, due to cardioembolism (36%), large-artery atherosclerosis (9%), small-artery occlusion (9%), other determined causes (6%), or undetermined causes (39%). The median NIHSS score after cardioembolic stroke (6, IQR: 3-13) was twice that after small-artery occlusion (3, IQR: 2-5). Among patients with cardioembolic stroke, 26% were diagnosed post-admission with atrial fibrillation. For the 42% diagnosed pre-admission, only 54% had prior prescriptions for oral anticoagulants. Reperfusion therapies were administered in 21% of cases, with significant variations across subtypes. Mortality rates were higher after cardioembolic strokes (17%) than after small-artery occlusions (3%). Prognostic factors included etiology, high NIHSS score, atrial fibrillation, and previous heparin prescription. ConclusionsWhile atrial fibrillation was underdiagnosed and undertreated, patients with cardioembolic stroke exhibited high severity and elevated mortality rates. Etiology emerged as an independent predictor of early mortality, regardless of NIHSS score upon admission. These findings underscore the importance of targeted prevention to improve patient outcomes after ischemic stroke.

Predictors of early mortality after lung transplantation for idiopathic pulmonary arterial hypertension.

Lung transplantation remains an important therapeutic option for idiopathic pulmonary arterial hypertension (IPAH),yet short-term survival is the poorest among the major diagnostic categories. We sought to develop a prediction model for 90-day mortality using the United Network for Organ Sharing database for adults with IPAH transplanted between 2005 and 2021. Variables with a pvalue ≤ 0.1 on univariate testing were included in multivariable analysis to derive the best subset model. The cohort comprised 693 subjects, of whom 71 died (10.2%) within 90 days of transplant. Significant independent predictors of early mortality were: extracorporeal circulatory support and/or mechanical ventilation at transplant (OR:3; CI: 1.4-5), pulmonary artery diastolic pressure (OR:1.3 per 10 mmHg; CI: 1.07-1.56), forced expiratory volume in the first second percent predicted (OR:0.8 per 10%; CI: 0.7-0.94), recipient total bilirubin >2 mg/dL (OR:3; CI: 1.4-7.2) and ischemic time >6 h (OR: 1.7, CI: 1.01-2.86). The predictive model was able to distinguish 25% of the cohort with a mortality of ≥20% from 49% with a mortality of ≤5%. We conclude that recipient variables associated with increasing severity of pulmonary vascular disease, including pretransplant advanced life support, and prolonged ischemic time are important risk factors for 90-day mortality after lung transplant for IPAH.

The role of the female gender on mid-term outcome after coronary artery bypass grafting: a retrospective study.

Data on female gender differences on clinical prognosis after coronary artery bypass grafting (CABG) are still controversial. We evaluated retrospectively the impact of women patients in comparison with men undergoing CABG on mid-term outcome. Between December 2014 and March 2022, 1,044 consecutive patients (162 females, 15.5%, 882 males, 84.5%) underwent isolated CABG. The mean follow-up was 40±27 (median 38) months. Logistic and Cox model analysis regressions were used to assess the risk of female gender and other variables, Kaplan-Meier estimates to assess survival rates. Women did not have a significant higher operative mortality than men (3.09% vs. 1.93%; P=0.37). There was no difference in the use of left internal mammary artery (97.5% vs. 94.9%; P=0.85). Independent predictors of early mortality were emergency CABG (P<0.0001), percutaneous coronary intervention (PCI) within 30 days (P=0.0026), and higher EuroSCORE II (P=0.0155). At 7.5 years, actuarial survival was 87%±3.6% for female gender vs. 88%±1.9% in male gender (P=0.41), freedom from cardiac death 97%±1.8% vs. 96.6%±1.0% (P=0.6), freedom from major adverse cardiac events (MACE) 87%±6.2% vs. 89.7%±2.5% (P=0.96). Independent predictor of all-causes death and cardiac death was the advanced age (74 years in dead patients vs. 67 years in survivors) (P<0.0001). Female gender was not a predictor of either operative mortality (P=0.34) or worse mid-term outcome (P=0.41). Women undergoing CABG with the same surgical techniques currently adopted for men, do not appear to be associated with worse early prognosis. Freedom from late all-causes mortality, cardiac death and adverse cardiac events are comparable and equally satisfactory, highlighting the positive protective effect of CABG over time also in women.

Abstract 13786: Early Mortality Following Transcatheter Edge-to-Edge Repair of Mitral Regurgitation

Background: While transcatheter edge-to-edge repair (TEER) is increasingly used, data on risk stratification for predicting early mortality after TEER are scarce. Objective: This study aimed to assess early mortality and analyze the predicting factor of early mortality among patients who underwent TEER. Methods: Using the all-payer, nationally representative Nationwide Readmissions Database, our study included patients aged 18 years or older who had TEER between January 2017 and November 2020. We categorized the cohort into two groups depending on the occurrence of early mortality (death within 30 days after the procedure). Based on the ICD-10, we identified the trend of early mortality after TEER and further analyzed the predictors of early mortality. Results: 15,931 patients who had TEER were included in this study; 292 (1.8%) with early mortality and 15,639 (98.2%) without. There was a decreasing trend in early mortality from 1.9% in 2017 to 1.7% in 2020, but it was insignificant (p=0.18). In multivariable analysis, the independent predictors for early mortality were chronic kidney disease not requiring dialysis (adjusted odds ratio [aOR]: 1.57; 95% confidence interval [CI]: 1.11-2.22, p=0.01), end-stage renal disease (aOR: 2.34; CI: 1.44-3.79, p&lt;0.01), chronic liver disease (aOR: 4.90; CI: 3.29-7.29, p&lt;0.01), coagulation disorder (aOR: 3.42; CI: 2.32-5.03, p&lt;0.01) and heart failure (aOR: 2.90; CI: 1.39-6.03, p=0.01). Among those who died during 30-day readmission following TEER, the most common cardiac cause and non-cardiac-cause of readmission were heart failure (18.2%) and infection (26.6%), respectively. Conclusion: The early mortality following TEER was low at 1.8%. The independent predictors of early mortality were chronic kidney disease (including end-stage renal disease), chronic liver disease, coagulation disorder, and heart failure. Figure Hazard Curves for Early Mortality after TEER Stratified by Clinical Predictors of Early Mortality.

The association between phosphate level at admission and early mortality in acute pancreatitis.

Abnormal phosphate levels are associated with adverse outcomes in critical illness. However, there is scarce evidence on phosphate's impact on acute pancreatitis outcomes, and the few studies examining this subject are relatively small and show conflicting data. We sought to determine the association between phosphate level at admission and the clinical course and outcomes of acute pancreatitis. In this retrospective single-center observational study, we included all adult patients admitted with a primary diagnosis of acute pancreatitis between January 2008 and June 2021. Phosphate levels at admission were classified as normal (2.8-4.5mg/dl), low (below 2.8mg/dl), or high (above 4.5mg/dl). Out of 2308 cases, 1868 patients had documented phosphate levels at admission and were thus included in our final analysis. 1096 (59%) had normal phosphate levels, 686 (37%) had hypophosphatemia, and 86 (4.6%) had hyperphosphatemia on admission. 30-day mortality rates were 3.4%, 3.8%, and 19% in normal, low, and high phosphate levels, respectively. In univariate analysis, hyperphosphatemia was significantly associated with 30-day mortality, with an OR of 6.54 (95% CI 3.39-12.2, p < 0.001; AUC = 0.58). In a multivariate analysis adjusting for age, MAP, GFR, BUN, and pH, hyperphosphatemia remained a statistically significant independent predictor of early mortality (OR-2.93, 95% CI 1.28-6.51, p = 0.009). Hypophosphatemia was not significantly associated with 30-day mortality in univariate analysis, OR of 1.13 (95% CI 0.67-1.87, p = 0.6). Hyperphosphatemia at admission was independently associated with increased 30-day mortality in patients with acute pancreatitis. Hypophosphatemia at admission was not significantly associated with 30-day mortality.

A Prospective Evaluation of Different Frailty Indices in Patients Undergoing Transurethral Resection of Bladder Tumor

BackgroundMost studies investigating the relationship between preoperative frailty and postoperative outcomes among bladder cancer patients only assess frailty retrospectively in patients who have undergone radical cystectomy. Transurethral resection of bladder tumor (TURBT) is a commonly performed procedure in outpatient settings for a large number of bladder cancer patients. The prevalence of frailty among bladder cancer patients and its impact on postoperative complications and mortality are not well studied. MethodsTo assess the prevalence of frailty among bladder cancer patients planned for TURBT at a tertiary cancer center using the modified frailty index (mFI) and Risk Analysis Index (RAI) and further assess the impact of these indices on 30-day postoperative complications and mortality rates. ResultsBetween May 2020 and March 2021, 343 consecutive patients were enrolled. The mean age of the cohort was 64.8 ± 13.1 years, 86.6% were male, and 82% had non–muscle-invasive bladder cancer (NMIBC). The majority of the cohort (92%) was found to have low American Society of Anesthesiologists (ASA) score class (I + II), while 35.3% were labeled as frail using mFI 2+, and 32.1% based on RAI (III, IV). The 30-day readmission, postoperative complications, and mortality rates in this cohort were 3.8%, 2.3%, and 6.6%, respectively. RAI was a better indicator of mortality compared to mFI. As such, patients with low RAI score (I, II) had 0.054 odds for 30-day mortality compared to the patients with high RAI score (III, IV) (OR 0.054; CI 95%, 0.004 to 0.784; P = 0.033).Conclusion Frailty, as measured by Risk Analysis Index, is an independent predictor of early mortality in patients undergoing TURBT. Preoperative frailty assessment may improve risk stratification and patient counseling prior to surgery.

Association between hypoalbuminemia and mortality in patients undergoing continuous renal replacement therapy: A systematic review and meta-analysis.

The review aimed to assess if hypoalbuminemia can predict mortality in patients undergoing continuous renal replacement therapy (CRRT). PubMed, Web of Science, Embase, and CENTRAL were searched for relevant articles published up to 24 July 2022. Adjusted data were pooled to calculate the odds ratio (OR). Sensitivity and meta-regression analysis was conducted. Five studies with 5254 patients were included. Meta-analysis of all five studies demonstrated that hypoalbuminemia was a significant predictor of mortality after CRRT (OR: 1.31 95% CI: 1.07, 1.60 I2 = 72% p = 0.01). The results did not change on sensitivity analysis. On meta-regression, we noted that variables like age, male gender, BMI, percentage of diabetics, and pre-CRRT SOFA score had no statistically significant influence on the outcome. Data from a limited number of studies suggest that hypoalbuminemia before initiation of CRRT is an independent predictor of early mortality. Based on current evidence, it may be suggested that patients with low albumin levels initiating CRRT should be prioritized and treated aggressively to reduce adverse outcomes.

Ministernotomy compared with right anterior minithoracotomy for aortic valve surgery.

Ministernotomy and right anterior minithoracotomy are the 2 main techniques applied for minimally invasive aortic valve replacement. The goal of this study is to compare early and long-term outcomes of both techniques. The data of 2419 patients undergoing isolated minimally invasive aortic valve replacement between 1999 and 2019 were prospectively collected. Retrospectively, patients were divided into the ministernotomy group (n=1352) and the minithoracotomy group (n=1067). After propensity score matching, 986 patients remained in each group. Operation time and rate of conversion to full sternotomy were significantly higher in the minithoracotomy group than in the ministernotomy group (184.6±45.2 vs 241.3±68.6, relative risk, 2.54, P=.005 and .09 vs .23, relative risk, 1.45, P=.013, respectively). The 30-day mortality, excluding cardiac death, was lower in the ministernotomy group than in the minithoracotomy group (0.012 vs 0.028, relative risk, 1.41, P=.011, respectively); the intensive care unit length of stay (12.4 vs 16.5, relative risk, 1.62, P=.037, respectively) and hospital length of stay (5.4 vs 8.7, relative risk, 1.74 P=.028, respectively) were significantly longer in the minithoracotomy group. The minithoracotomy surgical approach was the strongest independent predictor of early mortality (odds ratio, 4.24 [1.67-7.35], P=.002). The actuarial survival by Kaplan-Meier analysis at 1, 3, 5, 10, and 20years was significantly better in the ministernotomy group than in the minithoracotomy group (P=.0001). Actuarial freedom from reoperation at 5years was 97.3%±4.4% in the ministernotomy group versus 95.8%±5.2% in the minithoracotomy group (P=.087). Minimally invasive aortic valve replacement using ministernotomy is associated with reduced operative time, intensive care unit stay, hospital length of stay, and postoperative morbidities and incisional pain, and improves early and long-term mortality.

Cardiac adipose tissue volume assessed by computed tomography is a specific and independent predictor of early mortality and critical illness in COVID-19 in type 2-diabetic patients

BackgroundPatients with type 2-diabetes mellitus (T2D), are characterized by visceral and ectopic adipose tissue expansion, leading to systemic chronic low-grade inflammation. As visceral adiposity is associated with severe COVID-19 irrespective of obesity, we aimed to evaluate and compare the predictive value for early intensive care or death of three fat depots (cardiac, visceral and subcutaneous) using computed tomography (CT) at admission for COVID-19 in consecutive patients with and without T2D.MethodsTwo hundred and two patients admitted for COVID-19 were retrospectively included between February and June 2020 and distributed in two groups: T2D or non-diabetic controls. Chest CT with cardiac (CATi), visceral (VATi) and subcutaneous adipose tissue (SATi) volume measurements were performed at admission. The primary endpoint was a composite outcome criteria including death or ICU admission at day 21 after admission. Threshold values of adipose tissue components predicting adverse outcome were determined.ResultsOne hundred and eight controls [median age: 76(IQR:59–83), 61% male, median BMI: 24(22–27)] and ninety-four T2D patients [median age: 70(IQR:61–77), 70% male, median BMI: 27(24–31)], were enrolled in this study. At day 21 after admission, 42 patients (21%) had died from COVID-19, 48 (24%) required intensive care and 112 (55%) were admitted to a conventional care unit (CMU). In T2D, CATi was associated with early death or ICU independently from age, sex, BMI, dyslipidemia, CRP and coronary calcium (CAC). (p = 0.005). Concerning T2D patients, the cut-point for CATi was > 100 mL/m2 with a sensitivity of 0.83 and a specificity of 0.50 (AUC = 0.67, p = 0.004) and an OR of 4.71 for early ICU admission or mortality (p = 0.002) in the fully adjusted model. Other adipose tissues SATi or VATi were not significantly associated with early adverse outcomes. In control patients, age and male sex (OR = 1.03, p = 0.04) were the only predictors of ICU or death.ConclusionsCardiac adipose tissue volume measured in CT at admission was independently predictive of early intensive care or death in T2D patients with COVID-19 but not in non-diabetics. Such automated CT measurement could be used in routine in diabetic patients presenting with moderate to severe COVID-19 illness to optimize individual management and prevent critical evolution.

Early and Late Mortality Predictors in Patients with Acute Aortic Dissection Type B.

Despite technological advances in diagnosis and treatment, in-hospital mortality with acute aortic dissection type B is still about 11%. The purpose of this study was to assess the risk factors for early and long-term adverse outcomes in patients with acute aortic dissection type B treated medically or with conventional open surgery. The present study included 104 consecutive patients with acute aortic dissection type B treated in our Center from January 1st, 1998 to January 1st, 2007. Patient demographic and clinical characteristics as well as in-hospital complications were reviewed. Univariate and multivariate testing was performed to identify the predictors of in-hospital (30-day) and late (within 9 years) mortality. 92 (88.5%) patients were treated medically, while 12 (11.5%) patients with complicated acute aortic dissection type B were treated by open surgical repair. In-hospital complications occurred in 35.7% patients, the most often being acute renal failure (28%), hypotension/shock (24%), mesenteric ischemia (12%), and limb ischemia (8%). The in-hospital mortality rate was 15.7% and the 9-year mortality rate was 51.9%. Independent predictors of early mortality in patients with acute aortic dissection type B were uncontrolled hypertension (HR-20.69) and a dissecting aorta diameter >4.75 cm (HR-6.30). Independent predictors of late mortality were relapsing pain (HR-7.93), uncontrolled hypertension (HR-7.25), and a pathologic difference in arterial blood pressure (>20 mmHg) (HR-5.33). Knowledge of key risk factors may help with a better choice of treatment and mortality reduction in acute aortic dissection type B patients.

Determinants and prognostic value of in-hospital infection in patients waiting for permanent pacemaker implantation

BackgroundIn-hospital delays in permanent cardiac pacemaker (PPM) implantation are common and may result in in-hospital infection among patients waiting for PPM implantation (pre-PPM-HI). This study investigated the predictors and prognostic impact of these events. MethodsWe retrospectively evaluated 905 consecutive patients (68.2 ± 16.0 years; 54% males) who underwent PPM implantation. Clinical characteristics, pre-PPM-HI and 30-day mortality were recorded and a risk score for pre-PPM-HI was generated using multivariable logistic regression coefficients. ResultsEigthy-nine patients (10% of the sample) developed pre-PPM-HI. Multivariable logistic regression analysis identified urinary catheter use, complete atrioventricular block, implantation of temporary pacemaker and diabetes mellitus as independent predictors of pre-PPM-HI. The generated score (range 0–10.1) played a better role in predicting pre-PPM-HI than individual factors, yielding an area under the curve [95%CI] of 0.754 [0.705–0.803]. Patients with score ≥ 7.5 had 18-fold greater risk of developing pre-PPM-HI than those with score < 2.5. Furthermore, multivariable Cox-regression analysis showed that patients who developed pre-PPM-HI had greater 30-day mortality after PPM implantation (hazard ratio [95%CI] = 2.90 [1.18–7.16], p = 0.021) compared with their counterparts. ConclusionsThis study reveals that pre-PPM-HI is an independent predictor of early mortality after PPM implantation. In addition, a clinical score developed from simple clinical variables accurately identified patients at high risk of pre-PPM-HI. In scenarios where delays in PPM implantation are unavoidable, such as reference hospitals with high demand, the use of this tool can potentially help in the hierarchy of patients and in the reduction of this adverse event.

Clinical Predictors for Early Mortality of Patients with Acute Basilar Artery Occlusion

Background: Acute ischemic stroke due to basilar artery occlusion (BAO) is associated with the highest mortality in patients with large vessel occlusion. This study aimed to identify modifiable risk factors of early mortality in patients with BAO. Methods and Results: This was a cohort study of consecutive patients with BAO admitted to 47 stroke centers in China between January 2014 and May 2019. The primary outcome was all-cause mortality within 7 days after hospitalization. Of 829 patients, 164 died (0–3 days: 115; 4–7 days: 49) within 7 days after hospitalization. Among pre- and periprocedural variables, higher admission National Institutes of Health Stroke Scale (NIHSS, adjusted OR, 1.06, 95% CI: 1.04–1.09; p < 0.001), lower admission posterior circulation-Alberta Stroke Program Early Computed Tomography Score (pc-ASPECTS, adjusted OR, 0.88, 95% CI: 0.79–0.98; p = 0.02), lower Basilar Artery on Computed Tomography Angiography score (BATMAN, adjusted OR, 0.84, 95% CI: 0.76–0.93; p = 0.001), and recanalization failure (adjusted OR, 2.99, 95% CI: 2.04–4.38; p < 0.001) were independently associated with a higher risk of early mortality. Herniation (adjusted OR, 2.84, 95% CI: 1.52–5.30; p = 0.001) is an independent postprocedural predictor of early mortality. In patients dying ≤3 days, higher NIHSS (p < 0.001), lower pc-ASPECTS (p = 0.01), lower BATMAN (p = 0.004), recanalization failure (p < 0.001), herniation (p = 0.001), gastrointestinal hemorrhage (p = 0.046), and absence of pneumonia (p < 0.001) were independent predictors of early mortality. Higher NIHSS (p = 0.01), recanalization failure (p < 0.001), and pneumonia (p = 0.03) were independently associated with early mortality between 4 and 7 days. Conclusions: Recanalization failure, herniation, gastrointestinal hemorrhage, and pneumonia are potentially modifiable risk factors for early mortality in basilar artery occlusion.

Central nervous system involvement and thrombocytopenia as predictors of mortality in children with hemophagocytic lymphohistiocytosis

IntroductionHemophagocytic lymphohistiocytosis (HLH) is a potentially life-threatening condition. This study aimed to evaluate treatment outcomes and identify prognostic-related factors in Thai children with HLH.Materials and methodsWe retrospectively reviewed the medical records of 76 pediatric patients with HLH who were treated at Ramathibodi Hospital between January 2004 and December 2019. Treatment outcomes were defined as early mortality (death within 30 days after diagnosis) and early treatment response (resolution of all clinical features and normalization of at least one HLH-related laboratory parameter within 4 weeks).ResultsThe overall mortality rate was 38% (29/76), with an early mortality rate of 45% (13/29). Malignancy-associated HLH had the highest mortality rate (88%), followed by primary HLH (56%). The predictors of early mortality were central nervous system (CNS) involvement [OR 13 (95%CI 2–83), p = 0.007] and platelet counts <44 × 106/mm3 [OR 8 (95%CI 1.3–49), p = 0.024]. The predictors of early treatment response were no CNS involvement [OR 6.6 (95%CI 1.5–28.8), p = 0.011], platelet counts more than 44 × 106/mm3 [OR 8 (95%CI 2.1–30.9), p = 0.003], and total bilirubin levels <1.8 mg/dL [OR 4 (95%CI 1.1–14.8), p = 0.036]. In the mixed-model analysis, platelet counts in non-survivors increased significantly less than those in survivors, with a mean difference in platelet changes between the two groups of 94.6 × 106/mm3 (p = 0.003).ConclusionThe independent predictors of early mortality in children with HLH were CNS involvement and low baseline platelet counts. A slow rate of platelet increases during the first week after diagnosis was also associated with mortality.

Predictors of early mortality in multiple myeloma: Results from the Australian and New Zealand Myeloma and Related Diseases Registry (MRDR).

SummaryThe frequency and causes of early mortality in patients with newly diagnosed multiple myeloma (NDMM) have not been well described in the era of novel agents. We investigated early mortality in a prospective cohort study of all patients with NDMM registered on the Australian and New Zealand Myeloma and Related Diseases Registry (MRDR) at 36 institutions between July 2011 and March 2020. Early mortality was defined as death from any cause within the first 12 months after diagnosis. A total of 2377 patients with NDMM were included in the analysis, with a median (interquartile range) age of 67.4 (58.9–74.60 years, and 60% were male. Overall, 216 (9.1%) patients died within 12 months, with 119 (4.5%) having died within 6 months. Variables that were independent predictors of early mortality after adjustment in multivariable regression included age (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.05–1.08; p < 0.001), Eastern Cooperative Oncology Group performance status (OR 1.50, 95% CI 1.26–1.79; p < 0.001), serum albumin (OR 0.95, 95% CI 0.93–0.98; p < 0.001), cardiac disease (OR 1.96, 95% CI 1.35–2.86; p < 0.001) and International Staging System (OR 1.40, 95% CI 1.07–1.82; p = 0.01). For those with a primary cause of death available, it was reported as disease‐related in 151 (78%), infection 13 (7%), other 29 (15%). Infection was listed as a contributing factor for death in 38% of patients.

MO895: Comorbidity or Frailty, Which One Has a Greater Impact on Early Mortality in Incident Elderly Dialysis Patients?

Abstract BACKGROUND AND AIMS Mortality in end-stage renal disease remains high, especially among the elderly with a higher burden of comorbidity and frailty. In this group, dialysis (HD) may not offer better survival compared with conservative management. Frailty defined by clinical frailty scale (CFS) and comorbidity by modified Charlson Comorbidity Index (mCCI) are known independent predictors of mortality. Our aim is to compare that has higher impact on early mortality in incident elderly HD patients. METHOD We conducted a retrospective cohort study of patients aged 65 years and over, who started HD as their first renal replacement therapy (RRT) between January 2014 and December 2019. CFS and mCCI, at time of HD start, were used to evaluate, respectively, frailty and comorbid disease burden. The primary outcome was death in the first 6 months of RRT. The optimal cut-off for our outcome was defined through the analysis of a receiver operating characteristic (ROC) curve. Survival curves were constructed using Kaplan–Meier method, with comparison between patients' groups being done by log-rank test. Multivariable Cox analysis was applied to assess independent predictors of early mortality. All p values are two-tailed, p value &amp;lt; 0.05 is considered to indicate statistical significance. RESULTS 166 patients were included, 107 (64%) started HD by central venous catheter. The median age, at time of haemodialysis start, was 75 years ± 6.3 years. The mortality at 6 months was 19% (n = 31). For both scales, the analysis of ROC curve, stablished the optimal cut-off to predict the event death at first 6 months of HD as ≥ 5points. The performance of CFS was superior to the mCCI (P = 0.031; Figure 1 top). In fact, the area under the curve is higher in CFS (0.739) versus the mCCI (0.620). A CFS ≥ 5 had a sensitivity/specificity of 94%/44% in prediction the primary outcome. On the other and, a mCCI ≥ 5 predicts the same outcome with a sensitivity/specificity of 26%/88%. The diagnostic odds ratio for CFS ≥ 5 was 11.6, compared with only 2.7 for mCCI ≥ 5. When confronted using the Kaplan–Meier method, both CSF &amp;lt; 5 versus CSF ≥ 5 and mCCI &amp;lt; 5 versus mCCI ≥ 5 presented different survival rates that proved to be statistically significant by log rank test (P &amp;lt; 0.001 and P = 0.020, respectively; Figure 1 medium and bottom). CFS was an independent predictor of 6 month mortality both as a categorical (CSF ≥ 5) (HR = 3.64; P = 0.004) and continuous variable (HR = 1.95; P &amp;lt; 0.01). mCCI didn't prove to be an independent predictor. Lastly, we constructed a model in which both scores interacted (as categorical variables), in this multivariable adjusted model mCCI/CFS &amp;lt; 5/≥5 and ≥ 5/≥5 were intendent predictors of mortality (HR = 6.141; P = 0.022) (HR = 10.58; P = 0.002). Interestingly, no events were observed in the mCCI ≥ 5/CFS &amp;lt; 5 group. CONCLUSION In this cohort of incident elderly HD patients, frailty defined by CFS was a stronger predictor of mortality than comorbidity defined by CCI. The group of mCCI/CFS (≥5/≥5) has a 10-time higher chance of dying than the reference group. Our data also suggest that simple scores can predict the risk of early mortality in incident HD patients and should be used to guide the decision-making process for elderly patients and to improve the quality of the information given to patients and families.

Comparison of cases with and without additional lower body perfusion in newborns undergoing aortic arch reconstruction with antegrade selective cerebral perfusion method.

Background The aim of this study was to analyze the effect of additional lower body perfusion, compared to antegrade selective cerebral perfusion, on early postoperative outcomes after aortic arch repair in neonates with biventricular morphology. Methods Between January 2017 and April 2020, a total of 46 neonates (34 males, 12 females; median age: 10 days; range, 7 to 14 days) with biventricular morphology underwent an aortic arch reconstruction were retrospectively analyzed. The effects of antegrade selective cerebral perfusion and additional lower body perfusion techniques on vital organ preservation and mortality were evaluated in these patients who underwent arch reconstruction. Results In the univariate analysis of the whole cohort, postoperative creatinine level was lower in the additional lower body perfusion group, while there was no significant difference between the other parameters. In the multivariate analysis, intraoperative highest lactate level (odds ratio: 1.7; 95% confidence interval: 1.07-2.68; p=0.02) and postoperative 4th t o 6 th h lactate levels (odds ratio: 2.34; 95% confidence interval: 1.08-5.09; p=0.03) were independent predictors of early mortality. Mortality rate was higher in the antegrade selective cerebral perfusion group (22% vs. 7%), although it did not reach statistical significance. In the receiver operating characteristic curve analysis, the cut-off value for intraoperative lactate was 6.2 mmol/L (sensitivity: 85.7%, specificity: 71.1%) and the cut-off value for the lactate level at the postoperative 4th to 6th h was 4.9 mmol/L (sensitivity: 85.7%, specificity: 73.7%). Above these lactate levels were found to be associated with mortality. Conclusion Additional lower body perfusion may have a role in vital organ protection in aortic arch repair of neonates, compared to antegrade selective cerebral perfusion.

Incidence, clinical impact and predictors of thrombocytopenia after transcatheter aortic valve replacement

BackgroundThrombocytopenia is a common, yet poorly understood, complication after transcatheter aortic valve replacement (TAVR). Balloon-expandable transcatheter heart valve has been associated with higher incidence of thrombocytopenia, compared with self-expandable valves. The aim of this study was to analyze the incidence, clinical impact and predictors of acquired thrombocytopenia in patients undergoing TAVR. MethodsWe performed an observational study from consecutive patients with severe aortic stenosis undergoing TAVR (n = 679) in a single center. Association and best cut-off point of platelet decrease with early mortality was analyzed. Patients were classified according to postprocedural percentage decrease in platelet count (PDPC), comparing clinical outcomes and analyzing predictors of platelet decrease. ResultsThe median PDPC was 37.1 [IQR: 27.4–46.9]. PDPC was associated with early mortality (OR: 2.1, 95%IC: 1.7–2.5 for each 10% decrease, AUC:0.81, 95%CI:0.72–0.89) with an optimal cut-off point of 46%. PDPC≥46% and late nadir (≥4 days) were both independent predictors of early mortality (OR: 6.0 [IQR: 2.4–14.9] and OR: 5.1 [IQR: 2.2–11.6], respectively). The combination of both factors (PDPC≥46% and nadir ≥4 day) was associated with higher 2-year mortality (55.7%) compared to an early significant nadir (PDPC≥46% and nadir <4 day, 28.9%) and non-significant nadir (PDPC<46%, 21.0%), p < 0.001. Independent predictors of PDPC≥46% were baseline platelet count, Portico™, Abbott valve, intraprocedural major vascular complication and residual aortic regurgitation ≥grade 2. ConclusionThe platelet count decreased almost 40% after TAVR. Late nadir and PDPC≥46% predicted short-term clinical outcomes. Concomitant late and significant platelet decrease was associated with mid-term mortality.

Predictors of early mortality in early and late onset pancreatic cancer (PC).

543 Background: The incidence of early-onset PC (EOPC) is rising and is associated with substantial mortality. We sought to identify independent predictors of early mortality in a cohort of EOPC and matched older patients (pts). Methods: Pts with EOPC (≤50 years) and matched cohorts of average (51-69, AOPC) and late (≥70, LOPC) onset PC by sex, race, year of diagnosis, and presence of metastatic disease were identified using the institutional tumor registry for years 2011-2018. Demographic and clinicopathologic characteristics were retrieved. Overall time of survival was assessed using Kaplan-Meier curves and the Cox Proportional Hazards modeling. Multivariable regression was conducted to evaluate for predictors of early mortality in non-metastatic and metastatic pts, defined as either death within six months of diagnosis compared to those surviving at least 12 months. Results: In total, 100 pts with EOPC (median age 47, range 29-50), 100 pts with AOPC (median age 60, range 51-69), and 100 pts with LOPC (median age 78, range 70-93) were analyzed. Of these, 46% were female, 28% were black, and 43% had metastatic disease at presentation. In non-metastatic pts, the 12-mo. survival rate by age group was: EOPC 74.4% (95% CI 59-85), AOPC 60% (95% CI 43-73), and LOPC 32.4% (95% CI 18-47). Variables associated with mortality within 6 months of diagnosis in non-metastatic pts on univariable analysis included age group, BMI ≤25, ECOG performance status (PS), neutrophil-to-lymphocyte ratio ≥5 (NLR5), CA 19-9 ≥130, no surgical resection, and no adjuvant chemotherapy. Multivariable regression confirmed no surgical resection (Odds Ratio [OR] 9.6, 95% CI 3-29), no receipt of chemotherapy (OR 6.9, 95% CI 2-21), and NLR5 (OR 5.4, 95% CI 1-22) as independent predictors for early mortality in non-metastatic pts. In metastatic pts, the 12-mo. survival rate by age group was: EOPC 32.6% (95% CI 19-47), AOPC 27% (95% CI 15-41), and LOPC 5.8% (95% CI 1-16). On univariable analysis, variables associated with mortality within 6 months of diagnosis included age group, ECOG PS, and NLR5. Multivariable regression confirmed LOPC (OR 11.6, 95% CI 2-61) and NLR5 (OR 11, 95% CI 2-54) as independent variables for early mortality. Race, sex, BMI, CA 19-9, smoking, alcohol use, primary tumor location, and site of metastases were not associated with early mortality in metastatic pts. No difference in independent predictors of early mortality between EOPC and older pts were identified. Conclusions: In this cohort of EOPC and matched older pts, LOPC (age ≥70) and NLR5 were independently associated with early mortality by 6 months in metastatic pts. In non-metastatic pts, lack of curative intent surgery, no receipt of chemotherapy, and NLR5 were independently associated with early mortality. There were no independent predictors for early mortality that distinguished EOPC and older pts. Further work is needed to identify prognostic factors unique to EOPC.

Early mortality in patients with kidney failure starting chronic dialysis in Zambia: a retrospective cohort analysis

Introduction: Dialysis is the primary kidney replacement therapy for patients with kidney failure in sub-Saharan Africa. We assessed the rates and predictors of early mortality in Zambian patients starting chronic dialysis. Methods: This retrospective study included all patients who started chronic haemodialysis (HD) or peritonealdialysis (PD) between 1 January 2017 and 31 August 2020 at the three largest public dialysis centres in Zambia. Data on clinical, laboratory and dialysis characteristics were extracted from medical records. The primary outcome of interest was the mortality rate at 90 days. Results: A total of 154 patients were included in the study; 43.5% were female and 32% were 50 years or older.The main causes of kidney failure were hypertension (59%), glomerulonephritis (10%), HIV/AIDS (10%) andunknown (8%). The mortality rate at 90 days was 12.3%. Of these, 42% were cardiovascular-related mortalities and 32% died of infection related to central venous catheters. The lymphocyte percentage of total white blood cells was lower in patients who died compared to survivors (12.7 vs 20.8%) and was an independent predictor of early mortality (OR 0.914, 95% CI 0.850–0.983; P = 0.015). Conclusions: Early mortality was high in Zambian patients starting dialysis, and a low lymphocyte percentage was a predictor of mortality. Keywords: kidney replacement therapy, dialysis, Zambia, mortality

Does the timing of treatment with intraaortic balloon pump in cardiac surgery affect survival?

Background: The intraaortic balloon pump (IABP) is the most common mechanical assist device used as an adjunctive therapy for patients with low cardiac output among cardiac surgery. However, controversy still exists about the optimal time for IABP insertion. The study evaluated the association between timing of IABP insertion and outcome in cardiac surgical patients. Patients and Methods: Patients who underwent cardiac surgery between August 2007 and June 2014 were included. 273 of 3480 patients (7.84%) required perioperative IABP support. Of whom 21 (7.7%) received a preoperative IABP, 180 (65.9%) received an intraoperative IABP and 72 (26.4%) received a postoperative IABP. Predictors of early mortality were measured in stepwise multivariate logistic regression analyses. Results: The overall mortality rate for all patients requiring IABP was 29.3%. The incidence of mortality in patients who underwent pre-, intra- and postoperative IABP insertion was 19.0%, 22.8%, and 48.6%, respectively. The independent predictors of early mortality were age, cross clamp time, and postoperative IABP. However, either pre or intraoperative IABP insertion was not associated with increase in early mortality. Conclusions: IABP treatment in patients undergoing cardiac surgery was relatively safe accompanied by few complications. Timing of IABP insertion appears to be associated with survival as early insertion results are much more desirable compared to postoperative insertion.