Independent Prognostic Factor For Mortality Research Articles

Electrocardiographic Findings of COVID-19 Patients and Their Correlation with Outcome; a Prospective Cohort Study

Introduction: Being infected with COVID-19 is associated with direct and indirect effects on the cardiopulmonary system and electrocardiography can aid in management of patients through rapid and early identification of these adversities. Objective: The present study was designed aiming to evaluate electrocardiographic changes and their correlation with the outcome of COVID-19 patients. Methods: This Prospective cohort study was carried out on COVID-19 cases admitted to the emergency department of an educational hospital, during late February and March 2020. Electrocardiographic characteristics of patients and their association with in-hospital mortality were investigated. Results: One hundred and nineteen cases with the mean age of 60.52±13.45 (range: 29-89) years were studied (65.5% male). Dysrhythmia was detected in 22 (18.4%) cases. T-wave inversion (28.6%), pulmonale P-wave (19.3%), left axis deviation (19.3%), and ST-segment depression (16.8%) were among the most frequently detected electrocardiographic abnormalities, respectively. Twelve (10.1%) cases died. There was a significant correlation between in-hospital mortality and history of diabetes mellitus (p=0.007), quick SOFA score > 2 (p<0.0001), premature ventricular contraction (PVC) (p=0.003), left axis deviation (LAD) (p=0.039), pulmonale P-wave (p<0.001), biphasic P-wave (p<0.001), inverted T-wave (p=0.002), ST-depression (p=0.027), and atrioventricular (AV) node block (p=0.002). Multivariate cox regression showed that history of diabetes mellitus, and presence of PVC and pulmonale P-wave were independent prognostic factors of mortality. Conclusions: Based on the findings of the present study, 18.4% of COVID-19 patients had presented with some kind of dysrhythmia and in addition to history of diabetes, presence of PVC and pulmonale P-wave were among the independent prognostic factors of mortality in COVID-19 patients.

Gender-Based Differences by Age Range in Patients Hospitalized with COVID-19: A Spanish Observational Cohort Study.

There is some evidence that male gender could have a negative impact on the prognosis and severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The aim of the present study was to compare the characteristics of coronavirus disease 2019 (COVID-19) between hospitalized men and women with confirmed SARS-CoV-2 infection. This multicenter, retrospective, observational study is based on the SEMI-COVID-19 Registry. We analyzed the differences between men and women for a wide variety of demographic, clinical, and treatment variables, and the sex distribution of the reported COVID-19 deaths, as well as intensive care unit (ICU) admission by age subgroups. This work analyzed 12,063 patients (56.8% men). The women in our study were older than the men, on average (67.9 vs. 65.7 years; p < 001). Bilateral condensation was more frequent among men than women (31.8% vs. 29.9%; p = 0.007). The men needed non-invasive and invasive mechanical ventilation more frequently (5.6% vs. 3.6%, p < 0.001, and 7.9% vs. 4.8%, p < 0.001, respectively). The most prevalent complication was acute respiratory distress syndrome, with severe cases in 19.9% of men (p < 0.001). In men, intensive care unit admission was more frequent (10% vs. 6.1%; p < 0.001) and the mortality rate was higher (23.1% vs. 18.9%; p < 0.001). Regarding mortality, the differences by gender were statistically significant in the age groups from 55 years to 89 years of age. A multivariate analysis showed that female sex was significantly and independently associated with a lower risk of mortality in our study. Male sex appears to be related to worse progress in COVID-19 patients and is an independent prognostic factor for mortality. In order to fully understand its prognostic impact, other factors associated with sex must be considered.

Combined-Modality Therapy for Locally Advanced Esophageal Cancer in Endemic Region of Turkey: A Single-Center Multimodal Experience

Background: Esophageal cancer (EC) is known as the most common cancer around the world. The evidence supports that preoperative chemoradiotherapy (CRT) improves resectability and survival in locally advanced EC patients. Objectives: The current study aimed to evaluate the results of treatment in patients suffering from EC in an endemic region. Methods: In this study, a total of 180 EC patients treated with curative radiotherapy (RT) were retrospectively evaluated. Primary tumor location, histopathological characteristics, tumor, nodes, and metastases (TNM) status, gender, age, treatment modalities, and survival period were also assessed. The effects of prognostic factors on the survival rate were evaluated using single variable analysis. Results: The median time of follow-up was reported as 22.9 months (range: 6-115 months). After 1-, 3-, and 5-year follow-up, the rates of survival were calculated at 86.6%, 46.6%, and 32.5%, respectively. The present study was conducted on 77 (42.8%) male and 103 (57.2%) female patients (mean age: 60±12 years). In histopathological assessment, squamous cell carcinoma was the most frequent diagnosis (n=156; -86.6%). The clinical stages were reported as II in 36.6% (n=66), IIIa in 23.4% (n=42), IIIb in 15.5% (n=28), and IIIc in 24.5% (n=44) of the patients. In this study, 54 (25%) patients were treated with definitive RT, 33 patients (18.3%) with postoperative adjuvant CRT or RT, 59 patients (32.8%) with preoperative CRT or RT, and 43 patients (23.9%) with definitive CRT. The Eastern Cooperative Oncology Group (ECOG) performance status was observed to be ECOG 0 in 51 subjects (28.4%), ECOG 1 in 95 subjects (52.8%), and ECOG 2 in 34 subjects (18.8%). Moreover, 96 (53.4%) and 84 (46.6%) patients received conventional and conformal RT, respectively. The median time of overall survival (OS) was reported as 29 months. In univariate analysis, the T stage (P=0.041), N stage (P=0.033), TNM staging (P=0.00), and concomitant CRT (0.001) were prognostic factors affecting median OS time. Concomitant CRT (hazard ratio [HR]: 0.513; 95% CI: 0.337-0.779; P=0.002) and TNM stage (HR: 2.265; 95% CI: 1.409-3.641) were observed statistically significant as independent prognostic factors of mortality in multivariate analysis. Conclusions: Long-term survival using combined-modality therapy was demonstrated in patients with locally advanced EC. Furthermore, based on the results of multivariate analysis, TNM stage and concomitant CRT were considered independent prognostic factors of mortality.

Risk Factors for Mortality of COVID-19 Patient Based on Clinical Course: A Single Center Retrospective Case-Control Study.

Background: Epidemiological factors, clinical characteristics, and risk factors for the mortality of COVID-19 patients have been studied, but the role of complementary systems, possible inflammatory and immune response mechanisms, and detailed clinical courses are uncertain and require further study.Methods: In this single center, retrospective case-control study, we included all COVID-19 inpatients transferred or admitted to Wuhan Tongji Hospital from January 3 to March 30 2020 who had definite clinical outcomes (cured or deceased) with complete laboratory and radiological results. Clinical data were extracted from the electronic medical records, and compared between the cured and deceased patients. ROC curves were used to evaluate the prognostic value of the clinical parameters, and multivariable logistic regression analysis was performed to explore the risk factors for mortality. The correlation between the variables was evaluated by Spearman correlation analysis.Results: 208 patients were included in this study, 182 patients were cured and discharged, 26 patients died from COVID-2019. Most patients had comorbidities, with hypertension as the most common chronic disease (80; 38%). The most common symptoms at onset were fever (149; 72%), cough (137; 66%), and dyspnea (113; 54%). Elevated leucocytes, neutrophils, inflammatory biomarkers (CRP, ferritin, IL6, IL8, procalcitonin), PT, D-dimer, myocardial enzymes, BUN, decreased lymphocyte and subsets (T cells, CD4 T cells, CD8 T cells, NK cells, T cells + B cells + NK cells), and immunological factors (C3, C4) indicated poor outcome. PT, C3, and T cells were confirmed as independent prognostic factors for mortality by logistic regression models. IL6 and CPR were positively correlated with neutrophils, but negatively with lymphocytes and lymphocyte subsets except B cells. IL8 and ferritin were negatively related to T cells and CD4 T cells. Positive associations existed between C3 and T cells, CD4 T cells, and CD8 T cells, whereas there was no significant correlation between C4 and lymphocyte subsets. PT was found positively correlated with IL6, IL8, and CRP. Reverse correlations were explored between C3, C4, and PT, CK-MB, total bilirubin.Conclusions: T cells, C3, and PT were identified as independent prognostic factors for mortality. Decreased C3 and C4, dysregulation of lymphocyte subsets and cytokines may lead to death after SARS-CoV-2 infection.

Role of 68Ga-PSMA PET/CT parameters in treatment evaluation and survival prediction in prostate cancer patients compared with biochemical response assessment.

In this study, we aimed to evaluate the concordance of biochemical treatment response with gallium-68-prostate specific membrane antigen (68Ga-PSMA) positron emission tomography/computed tomography (PET/CT) treatment response in prostate cancer (PCa) and investigate their prognostic effects on survival. One hundred and fifty-onepatients with PCa, who underwent 68Ga-PSMA PET/CT imaging in our clinic between May 2016 and December 2019, were on treatment, and had pre-treatment and post-treatment imaging studies were included in our study. The treatment patients received and prostate-specific antigen (PSA) levels at the time of PET/CT imaging were recorded. Pre- and post-treatment whole-body metabolic tumor volume (MTVw), whole-body total lesion PSMA (TLPw), percent change in PSA (ΔPSA), ΔMTV, and ΔTLP values were calculated in all patients. Survival time of all patients was measured from the time of initial PET imaging. Median age of patients included in our study was 71 years (range: 51-88). When ΔPSA response and ΔTLP response were evaluated together (r: 0.71, P<0.001 and k: 0.541, P<0.001), statistically significance strong correlation and moderate concordance was observed. ΔPSA response and ΔMTV treatment response had statistically significant moderate correlation and moderate concordance (r: 0.66, P<0.01 and k: 0.454, P<0.001, significantly). Between ΔPSA response and ΔTLP and ΔMTV response had stronger correlation and higher concordance when PSA levels were above 10. Multivariate analyses using multiple Cox regression analysis revealed MTVw1 and ΔMTV parameters to be independent prognostic factors for mortality (P:0.003 and P:0.001, respectively). We observed that biochemical response and whole-body volumetric 68Ga-PSMA PET/CT parameter response showed correlation and concordance in all groups with PCa, which was more significant when PSA level was ≥10ng/mL. MTVw1 and ΔMTV parameters obtained via 68Ga-PSMA PET/CT were independent prognostic factors for mortality in PCa. Gallium-68-PSMA PET/CT is a valuable imaging technique for diagnostic purposes as well as follow-up and prognostic evaluation.

Prognostic nutritional index and the risk of mortality in patients with hypertrophic cardiomyopathy

AimsNutritional status has been related to clinical outcomes in patients with cardiovascular diseases. The prognostic impact of poor nutritional status in hypertrophic cardiomyopathy (HCM) is not clearly understood. The aim of the present study is to investigate the prognostic value of prognostic nutritional index (PNI), calculated from serum albumin level and total lymphocyte count, in HCM patients. MethodsA total of 393 HCM patients in a tertiary medical centre were enrolled. The primary and secondary endpoints were all-cause mortality and cardiovascular death. The association between PNI and endpoints was analysed. ResultsDuring a mean follow-up duration of 4.8 years, patients with high PNI values (PNI ≥ 48.8) had significantly lower incidence of all-cause mortality (9.3% vs. 33.1%, P < 0.001) and cardiovascular death (7.1% vs. 21.0%, P < 0.001). After adjusting for potential confounders, PNI was independently associated with all-cause mortality and cardiovascular death (hazard ratio per 1 SD increase: 0.46 [95% CI: 0.34–0.62, P < 0.001] and 0.44 [95% CI: 0.30–0.63, P < 0.001]). In subgroup analysis stratified by age, gender, New York Heart Association class, atrial fibrillation, estimated glomerular filtration rate, left ventricular ejection fraction or left ventricular outflow tract obstruction, PNI was consistently related to mortality. ConclusionsPNI is an independent prognostic factor for mortality in patients with HCM.

Elevated α-hydroxybutyrate dehydrogenase as an independent prognostic factor for mortality in hospitalized patients with COVID-19.

AimsMany studies have explored the clinical characteristics of patients with coronavirus disease (COVID‐19), especially patients with cardiovascular disease. However, associated mechanisms and markers remain to be further investigated. This study aimed to investigate the effect of α‐hydroxybutyrate dehydrogenase (α‐HBDH) levels on disease progression and prognosis of patients with COVID‐19.Methods and resultsOne thousand seven hundred and fifty‐one patients from the Leishenshan hospital in Wuhan were divided into elevated and normal groups by α‐HBDH level, and the clinical information between the two groups was compared retrospectively. The main outcome evaluation criteria included in‐hospital death and disease severity. Univariate and multivariate regression analyses, survival curves, logistic regression, and receiver operating characteristic curve models were performed to explore the relationship between elevated α‐HBDH and the two outcomes. Besides, curve fitting analyses were conducted to analyse the relationship between computed tomography score and survival. Among 1751 patients with confirmed COVID‐19, 15 patients (0.87%) died. The mean (SD) age of patients was 58 years in normal α‐HBDH group and 66 years in elevated α‐HBDH group (P < 0.001). The mortality during hospitalization was 0.26% (4 of 1559) for patients with normal α‐HBDH levels and 5.73% (11 of 192) for those with elevated α‐HBDH levels (P < 0.001). Multivariate Cox analysis confirmed an association between elevated α‐HBDH levels and higher risk of in‐hospital mortality [hazard ratio: 4.411, 95% confidence interval (95% CI), 1.127–17.260; P = 0.033]. Multivariate logistic regression for disease severity and α‐HBDH levels showed significant difference between both groups (odds ratio = 3.759; 95% CI, 1.895–7.455; P < 0.001). Kaplan–Meier curves also illustrated the survival difference between normal and elevated α‐HBDH patients (P < 0.001).ConclusionsOur study found that serum α‐HBDH is an independent risk factor for in‐hospital mortality and disease severity among COVID‐19 patients. α‐HBDH assessment may aid clinicians in identifying high‐risk individuals among COVID‐19 patients.

Usefulness of CHA2DS2-VAScScore to predict clinical outcomes of patients undergoing carotid artery stenting.

The CHA2DS2-VASc score predicts stroke and mortality risk in several cardiovascular diseases regardless of atrial fibrillation. In this study, we aimed to investigate the ability of CHA2DS2-VASc score to predict in-hospital and long-term outcomes in patients undergoing carotid artery stenting (CAS). The study population included 558 patients undergoing CAS. The patients were stratified into three groups based on their CHA2DS2-VASc scores [low (≤ 2, n = 123), moderate (3-5, n = 355) and high (6-8, n = 80)]. In-hospital and 3-year outcomes were compared between the groups. In-hospital rates of ipsilateral and major strokes and death were significantly different between the groups (1.6% vs. 3.9% vs. 16.2%; 1.6% vs. 4.5% vs. 16.2%; 0.8% vs. 3.1% vs. 13.8%, p < 0.001 for all, respectively). At 3years of follow-up, rates of ipsilateral and major strokes and death were significantly increased in patients with highscore compared to those with moderate and low scores (1.6% vs. 5.8% vs. 13%, p = 0.005; 0.8% vs. 5.2% vs. 13%, p = 0.001; 1.6% vs. 8.4% vs. 15.9%; p = 0.002, respectively). After adjusting for multi-model Cox regression analysis, CHA2DS2-VASc score persisted as an independent prognostic factor for mortality and major stroke in patients undergoing CAS. Higher CHA2DS2-VASc score predicted increased risk of in-hospital and 3- year stroke and mortality in patients undergoing CAS.

Factores pronósticos de mortalidad al año de una fractura de cadera por fragilidad ósea. Estudio Maluc Anoia

IntroductionMost of the patients who had a hip fragility fracture are characterized by advanced age, frailty, multimorbidity and high mortality rate into the first year. Our aim is to describe the prognostic factors of mortality one year after a hip fragility fracture. Material and methodsObservational prospective study. During the study period we included patients older than 69 years with hip fragility fracture who were admitted to the Acute Geriatric Unit. ResultsWe have followed 364 patients, 100 of them died (27.5%). The independent prognostic factors of mortality one year after a hip fragility fracture had been: have a less basis score in Lawton and Brody Scale 0.603 (0.505-0.721) (p< 0.001); have a higher score in Charlson Comorbidity Index 2.332 (1.308-4.157) p = 0.04); have a surgical waiting time ≥ 3 days 3.013 (1.330-6.829) p = 0.008); finding hydroelectrolytic disorders and/or deterioration of glomerular filtration 1.212 (1.017-1.444) p = 0.031) during hospital stay; discriminatory capacity of the area under the curve (AUC) (± 95%): 0.888 (0.880-0.891). ConclusionsPrognostic predictors of mortality at one year after a hip fragility fracture are those variables that reflect a worse state of health, complications during hospital stay and a longer surgical waiting time.

The impact of metabolic syndrome on morbidity and mortality among intensive care unit admitted COVID-19 patients

Background and aimsGiven the limited information describing the connection between metabolic syndrome (MetS) and Coronavirus Disease 2019 (COVID-19), we aimed to assess the impact of MetS on morbidity and mortality among COVID-19 patients. MethodsThis retrospective cohort study was performed from 1st April to May 3, 2020 on 157 ICU-admitted COVID-19 patients in Shahid Modarres Hospital in Tehran, Iran. Patients’ clinical, laboratory and radiological findings, and subsequent complications, were collected and compared between MetS and non-MetS groups. Results74 of all cases had MetS. Among the MetS components, waist circumference (p-value = 0.006 for men; p-value<0.0001 for women), Triglycerides (p-value = 0.002), and Fasting Blood Sugar (p-value = 0.007) were significantly higher in MetS group; with no statistical difference found in HDL levels (p-value = 0.21 for men; p-value = 0.13 for women), systolic blood pressure(p-value = 0.07), and diastolic blood pressure (p-value = 0.18) between two groups. Length of ICU admission (p-value = 0.009), the need for invasive mechanical ventilation (p-value = 0.0001), respiratory failure (p-value = 0.0008), and pressure ulcers (p-value = 0.02) were observed significantly more in MetS group. The Odds Ratio (OR) of mortality with 0(OR = 0.3660), 1(OR = 0.5155), 2(OR = 0.5397), 3(OR = 1.9511), 4(OR = 5.7018), and 5(OR = 8.3740) MetS components showed an increased mortality risk as the components’ count increased. The patient with BMI>40 (OR = 6.9368) had more odds of fatality comparing to those with BMI>35 (OR = 4.0690) and BMI>30 (OR = 2.5287). Furthermore, the waist circumference (OR = 8.31; p-value<0.0001) and fasting blood sugar (OR = 2.4588; p-value = 0.0245) were obtained by multivariate logistic regression as independent prognostic factors for mortality. ConclusionThe findings suggest a strong relationship between having MetS and increased risk of severe complications and mortality among COVID-19 ICU-admitted patients.

The association between peri-dialytic pulse wave velocity measurements and hemodialysis patient mortality.

Arterial stiffness in the general population is an independent prognostic factor for cardiovascular mortality, and can be measured noninvasively by pulse wave velocity (PWV). PWV is increased in hemodialysis (HD) patients, but the prognostic additional value remains debatable, with variable results reported. We wished to review whether increased PWV was associated with mortality in our HD patients. Aortic pulse wave velocity (PWVao) was measured peridialytic using an oscillograph technique (Arteriograph TensioMed, Hungary), in a cohort of HD patients in 2012. Three hundred and eighty-three HD patients, 238 (62.1%) male, median age 67.7 (54.2-78.0) years, 163 (42.6%) diabetic, Charlson comorbidity score 7 (5-9) and PWVao 8.9 (7.4-11.2) m/s were studied. Two hundred and twenty-nine deaths occurred during a median 61.1-month follow-up. PWVao was associated with all-cause mortality in unadjusted models (odds ratio [OR] for PWVao as a continuous variable 1.084, 95% confidence limits [CL] 1.046-1.124), P < 0.001, and for patients with PWVao>10 m/s (OR 1.61, CL 1.240-2.098, P < 0.001), but not after adjusting for clinical confounders (OR 1.024, CL 0.987-1.063, P = 0.208), whereas age (OR 1.049, CL 1.038-1.060, P < 0.001), and Charlson comorbidity (OR 1.131, CL1.065-1.201, P < 0.001) remained significantly associated with mortality. Although our HD patients with an increased PWVao had greater all-cause mortality, after adjustment for age and comorbidity, the prognostic value of a single PWVao measurement was no longer an independent prognostic factor for mortality. Future studies are required to determine whether changes in PWV offer additional prognostic value for HD patients.

Leucocyte Subsets Effectively Predict the Clinical Outcome of Patients With COVID-19 Pneumonia: A Retrospective Case-Control Study.

Background: The clinical characteristics of coronavirus disease 2019 (COVID-19) have been well-studied, while effective predictors for clinical outcome and research on underlying mechanisms are scarce.Methods: Hospitalized COVID-19 pneumonia patients with definitive clinical outcome (cured or died) were retrospectively studied. The diagnostic performance of the leucocyte subsets and other parameters were compared using the area under the receiver operating characteristic curve (AUC). Further, the correlations between leucocyte subsets and inflammation-related factors associated with clinical outcome were subsequently investigated.Results: Among 95 subjects included, 56 patients were cured, and 39 died. Older age, elevated aspartate aminotransferase, total bilirubin, serum lactate dehydrogenase, blood urea nitrogen, prothrombin time, D-dimer, Procalcitonin, and C-reactive protein levels, decreased albumin, elevated serum cytokines (IL2R, IL6, IL8, IL10, and TNF-α) levels, and a decreased lymphocyte count indicated poor outcome in patients with COVID-19 pneumonia. Lymphocyte subset (lymphocytes, T cells, helper T cells, suppressor T cells, natural killer cells, T cells+B cells+NK cells) counts were positively associated with clinical outcome (AUC: 0.777; AUC: 0.925; AUC: 0.900; AUC: 0.902; AUC: 0.877; AUC: 0.918, resp.). The neutrophil-to-lymphocyte ratio (NLR), neutrophil to T lymphocyte count ratio (NTR), neutrophil percentage to T lymphocyte ratio (NpTR) effectively predicted mortality (AUC: 0.900; AUC: 0.905; AUC: 0.932, resp.). Binary logistic regression showed that NpTR was an independent prognostic factor for mortality. Serum IL6 levels were positively correlated with leucocyte count, neutrophil count, and eosinophil count and negatively correlated with lymphocyte count.Conclusion: These results indicate that leucocyte subsets predict the clinical outcome of patients with COVID-19 pneumonia with high efficiency. Non-self-limiting inflammatory response is involved in the development of fatal pneumonia.

Prognostic significance of pre-procedural prognostic nutritional index in patients with carotid artery stenting

BackgroundInflammation and malnutrition play a critical role in the outcomes of patients undergoing carotid artery stenting (CAS). Prognostic nutritional index (PNI) is commonly utilized to evaluate the peri-operative immune-nutritional status of patients undergoing colorectal cancer surgery and is independently associated with survival. We assessed the association between immune-nutritional status, indexed by PNI, and outcomes in CAS patients. MethodsA total of 615 patients hospitalized for CAS in a tertiary heart center were enrolled in the study. PNI was calculated using the following formula: 10× serum albumin value (g/dL) + 0.005 × total lymphocyte count in the peripheral blood (per mm3). In-hospital and 5-year outcomes (ipsilateral stroke, major stroke, transient ischemic attack, myocardial infarction, and mortality) were compared between the tertiles of PNI. ResultsIn-hospital outcomes were similar between the groups except the increased mortality in decreasing tertiles of PNI. During a mean follow-up duration of 51.1 months, the lower PNI tertile was related to unfavorable outcomes. After adjusting for multi-model Cox regression analysis, PNI persisted as an independent prognostic factor for mortality and major stroke. ConclusionPNI was independently associated with long-term mortality and major stroke in CAS patients. Malnutrition and inflammation, which can be assessed easily and quickly using PNI, have an important prognostic value in the patients undergoing CAS.

Leucocyte Subsets Effectively Predict the Clinical Outcome of Patients with COVID-19 Pneumonia: A Retrospective Case-Control Study

Background: Clinical characteristics evaluation and risk factors identification of the coronavirus disease 2019 (COVID-19) have been well studied, while effective predictors for clinical outcome and research on underlying mechanism are limited. Methods: Hospitalized COVID-19 pneumonia patients with definitive clinical outcome (cured or died) were retrospectively studied. The diagnostic performance of the leucocyte subsets and other parameters were compared using the area under the receiver operating characteristic curve value (AUC). Further, the correlations between leucocyte subsets and inflammation related factors associated with clinical outcome were subsequently investigated. Findings: Among 95 subjects included, 56 patients were cured and 39 cases died. Older age, higher leucocytes count or neutrophil count, lower albumin levels, higher serum LDH levels, higher BUN levels, higher PT indicated poor outcome in patients with COVID-19 pneumonia. Lymphocyte subset (Lymphocyte, T cells, Th cells, Ts cells, NK cells, T cells+B cells+NK cells) counts were positively associated with cure rate (AUC: 0.777, P<0.001; AUC: 0.925, P<0.001; AUC: 0.900, P<0.001; AUC: 0.902, P<0.001; AUC: 0.877, P = 0.001; AUC: 0.918, P <0.001, resp.). Neutrophil-to-lymphocyte ratio (NLR), neutrophil to T lymphocyte count ratio (NTR), neutrophil percentage to T lymphocyte ratio (NpTR) effectively predicted the mortality (AUC: 0.900, P<0.001; AUC: 0.905, P<0.001; AUC: 0.932, P <0.001, resp.). Binary logistic regression showed that NpTR was independent prognostic factors for mortality. Serum IL6 level was positively correlated with lymphocyte count, neutrophil count and eosinophil count, while negatively correlated with lymphocyte count. Interpretation: These results indicate that leucocyte subsets predict the clinical outcome of patients with COVID-19 pneumonia in high efficiency. Non-self-limiting inflammatory response is involved in the development of fatal pneumonia. Funding Statement: This work was supported by National Natural Science Foundation of China (No.81702989). Declaration of Interests: The authors declare no conflict of interest. Ethics Approval Statement: This study was reviewed and approved by the ethics committee of Tongji Hospital of Huazhong University of Science and Technology (IRB ID: TJ- IRB20200343).

Impact of Cytomegalovirus Serostatus on Allograft Loss and Mortality Within the First Year After Kidney Transplantation: An Analysis of the National Transplant Registry

BackgroundCytomegalovirus (CMV) infection is one of the leading causes of morbidity and mortality in kidney transplantation (KT) recipients. We investigated the association of CMV serostatus and patient outcomes within the first year after KT. MethodsAll KT recipients between January 1, 2007 and December 31, 2017 were identified from the Thai Transplant Registry. The prevalence rates of allograft loss and mortality within the first year after KT were estimated by the Kaplan-Meier method. The CMV serostatus in donors (D) and recipients (R) was assessed as a prognostic factor for allograft loss and mortality within the first year by the Cox proportional hazards model. ResultsDuring the 10-year study period (2007-2017), there were 4556 KT recipients with a mean ± standard deviation age of 43 ± 14 years, and 63% of the recipients were male. Deceased-donor KT and induction therapy were performed in 52% and 58% of the recipients, respectively. Among the 3907 evaluable patients, the rates of cases with D+/R+, D+/R−, D−/R+, and D−/R− as the CMV serostatus were 88.9%, 6.1%, 2.9%, and 1.9%, respectively. The estimated prevalence rates of allograft loss and mortality within the first year were 3.8% and 2.8%, respectively. In univariate analysis, CMV D+/R− serostatus was significantly associated with mortality (hazard ratio [HR], 2.10; 95% confidence interval [CI], 1.18-3.75; P = .01) but not with an allograft loss (HR, 1.51; 95% CI, 0.85-2.66; P = .16) within the first year after KT. In multivariate analysis, CMV D+/R− serostatus of D+/R− was associated with mortality within the first year after KT (HR, 2.04; 95% CI, 1.05-3.95; P = .04). Other independent prognostic factors for mortality were old recipient age, deceased-donor KT, and hemodialysis after KT. ConclusionsIn a national setting with predominant CMV seropositivity in both D and R, CMV seromismatch was associated with poor patient survival within the first year after KT.

Low Expression of Phosphatase and Tensin Homolog and High Expression of Ki-67 as Risk Factors of Prognosis in Cranial Meningiomas

To investigate the expression characteristics, correlations with clinical factors, and prognostic values of phosphatase and tensin homolog (PTEN) and Ki-67 in cranial meningiomas. The expression of PTEN and Ki-67 at the mRNA level was analyzed in 34 frozen meningiomas. Clinical data collection, follow-up, correlations, and survival analyses were performed. Twenty-two men and 12 women were included in the study, with a median age of 52.72 ± 11.72 years on admission. The average expression levels of PTEN and Ki-67 were 2.71 ± 1.73 and 0.50 ± 0.57, respectively. The World Health Organization grade III meningiomas exhibited significantly lower levels of PTEN (P= 0.037), whereas grade I meningiomas expressed significantly lower levels of Ki-67 (P= 0.001). For recurrent lesions, the mean Ki-67 expression level was 0.97 ± 0.76, which was significantly greater than that of primary meningiomas with a mean value of 0.25 ± 0.13 (P < 0.001). The Ki-67 expression level was positively correlated with the tumor volume (P < 0.01) and negatively correlated with preoperative Karnofsky Performance Status scale (KPS, P < 0.01), postoperative KPS (P < 0.05), and follow-up KPS (P < 0.01). However, the PTEN expression level did not correlate with these variables. Based on the multivariate Cox analysis, Ki-67 expression level (P < 0.001, hazard ratio [HR] 8.16, 95% confidence interval [CI] 2.86-23.29), and PTEN expression level (P= 0.018, HR 0.47, 95% CI 0.25-0.88) were independent prognostic factors for tumor recurrence. Ki-67 (P= 0.001, HR 19.73, 95% CI 3.65-106.61) and PTEN expression levels (P= 0.024, HR 0.36, 95% CI 0.15-0.88) were also independent prognostic factors for mortality. A low PTEN expression and a high Ki-67 expression could predict malignancy in cranial meningiomas.

Risk of Long-Term Mortality for Complex Chronic Patients with Intracerebral Hemorrhage: A Population-Based e-Cohort Observational Study.

Over recent years there has been growing evidence of increased risk of mortality associated with hemorrhagic stroke among older patients. The main objective of this study is to propose and validate a prognostic life table for complex chronic patients after an intracerebral hemorrhage (ICH) episode in primary care settings. This was a multicenter and retrospective study (April1, 2006-December31, 2016) of a cohort from the general population presenting an episode of ICH from which a predictive model of mortality was obtained using a Cox proportional hazards regression model. In addition, Kaplan-Meier survival curves, the log-rank test, receiver operating characteristic (ROC) curves, and area under the ROC curve (AUC) were used to evaluate the ability to stratify patients according to vital prognosis. We proceeded to external validation of the model through prospective monitoring (January1, 2013-December31, 2017) of the population of complex chronic patients with an episode of ICH. A total of 3594 people aged ≥ 65years were identified as complex chronic patients (women 55.9%; mean age, 86.1 ± 8.4years) of whom 161 suffered hemorrhagic stroke during the study period (January 1, 2013-December 31, 2017). The primary outcome was death from any cause within 5years of follow-up after an ICH episode. The independent prognostic factors of mortality were age > 80years (HR 1.048, 95% CI 1.021-1.076, p < 0.001) and HAS-BLED score (HR 1.369, 95% CI 1.057-1.774, p = 0.017). Compared to the general population, the incidence density/1000 person per year (15 vs 0.22) was significantly higher with a significantly lower annual lethality rate (17% vs 49.2%); and both the prognostic factors and the risk of stratified mortality showed different epidemiological patterns. The internal validation of the model was optimal (log-rank < 0.0001) in the general population, but its external validation was not significant in the complex chronic patient population (log-rank p = 0.104). The ICH-AP is a clinical scale that can improve the prognostic prediction of mortality in primary care after an episode of ICH in the general population, but it was not significant in its external validation in a population of complex chronic patients. ClinicalTrials.gov ID: NCT03247049.

1743. Impact of Cytomegalovirus Serostatus on Allograft Loss and Mortality within the First Year after Kidney Transplantation: An Analysis of the National Transplant Registry

BackgroundCytomegalovirus (CMV) infection is one of the leading causes of morbidity and mortality in kidney transplant (KT) recipients. We investigated the association of CMV serostatus and allograft outcome within the first year after KT.MethodsAll KT recipients from 2007 to 2017 were derived from the Thai Transplant Registry. The prevalence of allograft loss and mortality within the first year after KT was estimated by Kaplan–Meier analysis. CMV serostatus of the donor (D) and the recipient (R) was assessed as a prognostic factor of allograft loss and mortality by Cox proportional hazards models.ResultsDuring a 10-year study period, the population consisted of 4,556 KT recipients with a mean ± SD age of 43 ± 14 years and 63% were male. Fifty-two percent underwent deceased donor KT and 58% received induction therapy. Among 3,907 evaluable patients, the CMV seroprevalence were D+/R+ (88.9%), D+/R− (6.1%), D−/R+ (2.9%), and D−/R− (1.9%). The estimated prevalence of allograft loss and mortality within the first year were 3.8 and 2.8%, respectively. In univariate analysis, CMV D+/R- was significantly associated with mortality within the first year after KT [hazard ratio (HR), 2.10; 95% confidence interval [CI], 1.18–3.75 (P = 0.01)] however not with an allograft loss [HR, 1.51; 95% CI, 0.85–2.66 (P = 0.16)]. In multivariate analysis, CMV D+/R- serostatus was associated with mortality within the first year after KT [HR, 2.04; 95% CI, 1.05–3.95 (P = 0.04)]. Other independent prognostic factors for mortality were older recipient age, deceased donor KT, and hemodialysis after KT (Table 1).ConclusionIn the setting where the donor and recipient CMV seropositivity is predominant, CMV seromismatch still negatively affects patient survival within the first year after KT. Disclosures All authors: No reported disclosures.

Mild hyponatremia discovered within the first 24 hours of ischemic stroke is a risk factor for early post stroke mortality.

Comorbidities, complications and laboratory abnormalities are common in stroke patients. One of the common problems is hyponatremia (serum sodium (Na) level <135 mmol/L), but the relationship between hyponatremia and the prognosis in patients with stroke is not well understood. The aim of this study was to investigate the prevalence and severity of hyponatremia, as well as its impact on prognosis in stroke patients on admission to hospital. The study involved the analysis of the first measurement of the Na level after the admission and its correlations with comorbidities, the scale of clinical assessment of stroke severity (NIHSS), the size and location of the stroke, and mortality. A retrospective study was conducted on 502 patients (among them 263 women) admitted to the hospital on stroke onset (440 ischemic stroke (IS) and 62 hemorrhagic stroke (HS) patients). The post-stroke mortality was defined as early if death occurred within 30 days. Hyponatremia was found in 18.4% of patients with IS and 25.8% of patients with HS, irrespective of age and gender. Hyponatremia is an independent prognostic factor of mortality in people with IS (p = 0.003). Na levels were lower in IS patients who died than in those who remained alive (134.8 ±4.99 mmol/L vs 136.6 ±3.01 mmol/L; p = 0.02). Higher mortality rate was observed among IS patients under 75 years of age and Na level ≤132 mmol/L. In patients with IS, hyponatremia correlates with NIHSS (p = 0.005) and the size and location of the stroke (p = 0.002). Hyponatremia is more frequently observed in patients with HS than IS. Mild hyponatremia is already known to be an independent prognostic factor in the mortality of people with IS and it may also have value as a prognostic factor in the mortality of the IS population. In a patient with a suspected stroke, there is a need to control electrolyte levels at the onset of the stroke, especially in patients with comorbidities, irrespective of age.

2457-PUB: Microcirculatory Alterations Are Associated with Increased Risk of Total Death in Patients with Type 2 Diabetes

Rationale and Objective: It has been well known that patients with diabetes had shorter life expectancy, compared to patients without diabetes. Although several studies have been reported the significance of microciculatory dysfunction particularly in the early phase of critical illness, it has been not reported the association between microcirculatory dysfunction and long-term prognosis. Therefore, we evaluated the relationship between microcirculatory dysfunction and the risk of total death in patients with type 2 diabetes. Methods: A total of 1017 patients with diabetes (657 men and 360 women), who were admitted to the department of internal medicine from September 2015 to December 2017, were included in this study. We measured perfusion index (PI), which could reflect microcirculation, using a pulse oximeter (Masimo Radical 7; Masimo Corp., Irvine, CA, U.S.) on the day of admission. Cox proportional hazards models was used in multivariate analysis. Results: The median duration of follow-up was 670.0 days and a total of 117 patients died during follow-up duration. The average age, HbA1c and PI value was 71.0 ± 11.6 years, 7.7 ± 1.9% and 3.2 ± 2.4%. PI value was negatively correlated with age (β = -0.18, P &amp;lt; 0.0001), pulse rate (β = -0.06, P = 0.04) and serum creatinine (β = -0.16, P &amp;lt; 0.0001). PI value was positively correlated with body mass index (β = 0.11, P = 0.0007) and hemoglobin level (β = 0.19, P &amp;lt; 0.0001). Adjusted Cox regression analyses demonstrated that PI value was associated with an increased hazard of total death; hazard ratios were 1.11 (95% confidence interval, 1.01 - 1.23). Conclusion: The present study indicates the importance of microciculatory dysfunction and monitoring as a potential independent prognostic factor of mortality in patients with type 2 diabetes. Disclosure H. Okada: None. Y. Okada: None. M. Fukui: Research Support; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Eli Lilly and Company, Johnson &amp; Johnson, Kyowa Hakko Kirin Co., Ltd., Merck &amp; Co., Inc., Mitsubishi Tanabe Pharma Corporation, Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Sanofi, Sanwa Kagaku Kenkyusho, Takeda Pharmaceutical Company Limited. Speaker's Bureau; Self; AstraZeneca, Eli Lilly and Company, Kowa Pharmaceutical Europe Co. Ltd., Kyowa Hakko Kirin Co., Ltd., Merck &amp; Co., Inc., Mitsubishi Tanabe Pharma Corporation, Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Sanofi, Sanwa Kagaku Kenkyusho, Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited.