Intermediate-term Mortality Research Articles

The relationship of plasma glucose, stress hyperglycaemia and glycated haemoglobin with intermediate-term mortality after acute myocardial infarction in patients with and without diabetes.

Admission hyperglycaemia is an adverse prognostic indicator in the setting of acute myocardial infarction. It is unclear if this is because of previously undiagnosed diabetes, due to admission plasma glucose being a marker of a greater stress hormone response and therefore a more severe event, or due to a detrimental effect of high blood glucose on the myocardium. We performed retrospective analysis of a cohort of 430 participants admitted with a diagnosis of acute myocardial infarction. We investigated the relation of admission plasma glucose, glycated haemoglobin, stress hyperglycaemia ratio and a novel parameter; the stress hyperglycaemia index, to mortality by Cox regression analyses. The stress hyperglycaemia index is the difference between the admission glucose and glucose estimated from HbA1c. We included 430 participants who were followed for a median of 2.5 years. The stress hyperglycaemia index was associated with increased mortality in patients with diabetes in both univariate and multivariate analyses. Admission glucose was associated with mortality in subjects with diabetes in univariate analysis and after adjustment of age and sex, but not after adjusting for eGFR. There was no significant association between admission glucose and mortality in subjects without diabetes. HbA1c was not associated with mortality in either patient group in both univariate and multivariate analyses. Our results suggest a possible detrimental effect of hyperglycaemia in the setting of an acute myocardial infarction.

Assessment of intermediate-term mortality following pancreatectomy for cancer.

Pancreatic cancer remains highly lethal, and resection represents the only chance for cure. Although patients are counseled regarding short-term (0-3 months) mortality, little is known about mortality 3-6 months (intermediate-term) following surgery. We assessed predictors of intermediate-term mortality, evaluated hospital-level variation, and developed a nomogram to predict intermediate-term mortality risk. Patients undergoing pancreatic cancer resection were identified from the National Cancer Database (2010-2020). Multivariable logistic regression identified predictors of intermediate-term mortality and assessed differences between short-term and intermediate-term mortality. Multinomial regression grouped by intermediate-term mortality quartiles evaluated hospital-level variation. A neural network model was constructed to predict intermediate-term mortality risk. All statistical tests were 2-sided. Of 45 297 patients, 3974 (8.9%) died within 6 months of surgery of which 2216 (5.1%) were intermediate-term. Intermediate-term mortality was associated with increasing T category, positive nodes, lack of systemic therapy, and positive margins (all P < .05) compared with survival beyond 6 months. Compared with short-term mortality, intermediate-term mortality was associated with treatment at high-volume hospitals, positive nodes, neoadjuvant systemic therapy, adjuvant radiotherapy, and positive margins (all P < .05). Median intermediate-term mortality rate per hospital was 4.5% (interquartile range [IQR] = 2.6-6.5). Highest quartile hospitals had decreased odds of treatment with neoadjuvant systemic therapy, neoadjuvant radiotherapy, and adjuvant radiotherapy (all P < .05). The neural network nomogram was highly accurate (accuracy = 0.9499; area under the receiver operating characteristics curve = 0.7531) in predicting individualized intermediate-term mortality risk. Nearly 10% of patients undergoing pancreatectomy for cancer died within 6 months, of which one-half occurred in the intermediate term. These data have real-world implications to improve shared decision making when discussing curative-intent pancreatectomy.

Heart Transplant Outcomes in Older Adults in the Modern Era of Transplant.

Because of advances in medical treatment of heart failure, patients are living longer than in previous eras and may approach the need for advanced therapies, including heart transplantation, at older ages. This study assesses practices surrounding heart transplant in older adults (> 70 years) and examines short- and medium-term outcomes. This study is a retrospective analysis using the United Network for Organ Sharing (UNOS) database from 2010 to 2021. The absolute number of older adults being transplanted is increasing. Older adults were more likely to have had a prior malignancy or ischemic cardiomyopathy and less likely to be on extra-corporeal membrane oxygenation or have a high UNOS status prior to transplant. Mortality at 1-year was higher for older adults (27.8%vs. 23.4%), but at 5 years there was no significant difference (22.3%vs. 19.4%.). Older adults were more likely to die of malignancy or infection. Adults under 70 were more likely to die of cardiovascular causes or graft failure. There was less rejection in older adults. Mortality has not changed for older adults transplanted before versus after the 2018 UNOS allocation change. Carefully selected older adults may be considered for heart transplantation, given similar intermediate-term mortality.

Outcomes associated with postoperative cognitive dysfunction: a systematic review and meta-analysis.

Postoperative cognitive dysfunction (POCD) manifests as a subtle decline in cognition, potentially leading to unfavourable postoperative outcomes. We explored the impact of POCD on physical function, length of hospital stay (LOS), dementia and mortality outcomes. PubMed and Scopus were searched until May 2023. All studies of major surgical patients that assessed POCD and outcomes of interest were included. POCD effects were stratified by surgery type (cardiac and noncardiac) and time of POCD assessment (<30 and ≥30days postsurgery). Of 2316 studies, 20 met the inclusion criteria. POCD was not associated with functional decline postsurgery. Patients who experienced POCD postcardiac surgery had an increased relative risk (RR) of death of 2.04 [(95% CI: 1.18, 3.50); I2= 0.00%]. Sensitivity analyses showed associations with intermediate-term mortality among noncardiac surgical patients, with an RR of 1.84 [(95% CI: 1.26, 2.71); I2= 0.00%]. Patients who developed POCD <30days postcardiac and noncardiac surgeries experienced longer LOS than those who did not [mean difference (MD) = 1.37days (95% CI: 0.35, 2.39); I2= 92.38% and MD = 1.94days (95% CI: 0.48, 3.40); I2= 83.29%, respectively]. Postoperative delirium (POD) may contribute to the heterogeneity observed, but limited data were reported within the studies included. Patients undergoing cardiac and noncardiac surgeries who developed POCD <30days postsurgery had poorer outcomes and an increased risk of premature death. Early recognition of perioperative neurocognitive disorders in at-risk patients may enable early intervention. However, POD may confound our findings, with further studies necessary to disentangle the effects of POD from POCD on clinical outcomes.

The Association Between Systemic Immune Inflammation Index and Intermediate-Term Mortality in Patients with Acute Coronary Syndromes

Background: ic immune inflammation has been investigated as a prognostic marker for different disea-ses. Considering the pivotal role of inflammation in the pathogenesis of acute coronary syndrome (ACS), it is paramount to predict the prognosis of patients with ACS. Therefore, we evaluated the association between inflammation measured by the systemic immune-inflammation index (SII) and middle-term mortality in patients with ACS. Materials and Methods: This single-center, retrospective study was composed of 539 patients with ACS (139 unstable angina pectoris [USAP], 165 non-ST-elevation myocardial infarction [NSTEMI], and 235 ST-elevation myocardial infarction [STEMI]) aged over 18 years. Descriptive statistics and multivari-ate regressions were used to examine the association between clinical and laboratory parameter characteristics and 12-month mortality. Results: The median age of the patients was 58 (50-67) and 73.1% of the patients were male. A total of 20 patients died in the next twelve months after ACS event. The median SII levels were highest in patients with STEMI [1301.96 (816.81-2174.53)] , followed by NSTEMI [955.50 (619.99-1576-06] and USAP [595.32 (437.52-918.27)] (p&amp;lt;0.001). The SII had moderate success for the prediction of the intermediate-term mortality (AUC: 0.653, 95% CI: 0.526-0.779, p=0.024). In multivariate analyses, every 100-unit increase in SII was associated with a two percent increase in the risk of intermediate mortality (OR: 1.020, 95% CI: 1.004-1.037, p=0.016). Conclusions: We demonstrated that ACS patients with higher SII levels had a higher risk of mortality at twelve months, and higher SII levels were associated with a more severe underlying ACS etiology. If supported by prospective evidence, the SII index may guide clinicians in terms of both ACS severity and subsequent one-year survival rates.

All-cause mortality risks among participants in mass-participation sporting events

ObjectivesExercise transiently increases the risk for sudden death, whereas long-term exercise promotes longevity. This study assessed acute and intermediate-term mortality risks of participants in mass-participation sporting events.MethodsData of participants in...

Postoperative thrombocytopenia and subsequent consequences in acute type A aortic dissection

ObjectivesTo ascertain if postoperative thrombocytopenia following open aortic surgery with a median sternotomy can predict early- and intermediate-term morbidity and mortality.MethodsFrom January 2018 to December 2022, a comparison was made between patients who had and didn’t have postoperative thrombocytopenia (defined as a nadir < 75 × 103/μL after 72 h of open aortic surgery with median sternotomy). Intermediate-term mortality during follow-up was the main result, with cerebrovascular accident and acute renal injury requiring dialysis as secondary events. Inverse probability treatment weighting (IPTW) was used to account for selection bias between groups. The Kaplan-Meier method with the log-rank test was used to assess intermediate-term survivals following IPTW modification. To identify the nonlinear link between platelet nadir and mortality probability, a generalized additive mix model was applied. To help increase power in testing for the overall effect of platelet nadir on outcomes in the generalized additive mix model, the hazard ratios and 95% CIs for each subgroup and their interactions were examined.ResultsThe study included 457 patients, 347 male (75.9%), with mean age of 54 ± 12 years. The last follow-up was done on April 14th, 2023 and the median follow-up time was 16 (6-31) months. Following IPTW, patient characteristics were balanced among cohorts. Platelet nadir was found to be significantly inversely related to early-term mortality (IPTW-adjusted hazard ratio = 0.968 (0.960, 0.977), p < 0.001), and AKI requiring dialysis (IPTW-adjusted hazard ratio = 0.979 (0.971, 0.986), p < 0.001). A nonlinear relationship between platelet nadir and mortality risk probability during follow-up visually showed that the likelihood of mortality decreased with platelet nadir increased. In confounder-adjusted survival (‘postoperative thrombocytopenia not acquired’ vs ‘postoperative thrombocytopenia’; HR: 0.086 [95% CI: 0.045-0.163]; p < 0.01) analysis, non-acquired postoperative thrombocytopenia was associated with a lower risk of mortality, and the treatment benefit was validated in IPTW-adjusted analysis, which showed an HR of 0.067.ConclusionsEarly postoperative thrombocytopenia following type A aortic dissection surgery is a risk factor for morbidity and mortality. Because postoperative thrombocytopenia can indicate a poor prognosis, monitoring early postoperative platelets helps identify individuals who may develop late postoperative problems, which is performed by this affordable biomarker.

Intermediate-Term Prognostic Value of Homocysteine in Acute Coronary Syndrome Complicated with or without Hypertension: A Multicenter Observational Cohort Study.

As a classical biomarker associated with hypertension, the prognostic value of homocysteine (Hcy) in the intermediate-term outcome of acute coronary syndrome (ACS) remains controversial. This study aimed to investigate the role of homocysteine in ACS patients with different blood pressure statuses. A total of 1288 ACS patients from 11 general hospitals in Chengdu, China, from June 2015 to December 2019 were consecutively included in this observational study. The primary endpoint was defined as all-cause death. Secondary endpoints included cardiac death, nonfatal myocardial infarction (MI), unplanned revascularization and nonfatal stroke. The patients in the hypertension group (n = 788) were further stratified into hyperhomocysteinemia (H-Hcy, n = 245) and normal homocysteinaemia subgroups (N-Hcy, n = 543) around the cut-off value of 16.81 µmol/L. Similarly, the nonhypertensive patients were stratified into H-Hcy (n = 200) and N-Hcy subgroups (n = 300) around the optimal cut-off value of 14.00 µmol/L. The outcomes were compared between groups. The median follow-up duration was 18 months. During this period, 78 (6.05%) deaths were recorded. Kaplan‒Meier curves illustrated that H-Hcy had a lower survival probability than N-Hcy in both hypertension and nonhypertension groups (p 0.01). Multivariate Cox regression analysis revealed that H-Hcy was a predictor of intermediate-term mortality in ACS, regardless of blood pressure status. Elevated Hcy levels predict intermediate-term all-cause mortality in ACS regardless of blood pressure status. This association could be conducive to risk stratification of ACS. The study was registered in the Chinese Clinical Trials Registry in China (ChiCTR1900025138).

Clinical and Echocardiographic Features of Patients With Infective Endocarditis and Bicuspid Aortic Valve According to Echocardiographic Definition of Valve Morphology

Clinical and Echocardiographic Features of Patients With Infective Endocarditis and Bicuspid Aortic Valve According to Echocardiographic Definition of Valve Morphology

How We Would Treat Our Own Hypoplastic Left Heart Syndrome Neonate for Stage 1 Surgery

How We Would Treat Our Own Hypoplastic Left Heart Syndrome Neonate for Stage 1 Surgery

Observation, Radiotherapy, or Radical Prostatectomy for Localized Prostate Cancer: Survival Analysis in the United States.

Contemporary treatment strategies for localized prostate cancer (PCa) have been evolved over time. However, there is little data regarding survival outcomes based on initial treatment by risk group in this new era. This study aims to evaluate survival outcomes among men who underwent observation, radiotherapy, or radical prostatectomy for localized PCa using a population-based cohort. The Surveillance, Epidemiology, and End Results (SEER) prostate with watchful waiting dataset (2010-2016) was used. We included men diagnosed with localized PCa and clinical stage T1c-2cN0M0. Other inclusion criteria were age 50-79 years, prostate-specific antigen (PSA) ≤50 ng/mL, and initial treatment with observation (active surveillance/watchful waiting), radiotherapy, or radical prostatectomy. PCa risk was assessed using the D'Amico classification. The primary endpoint was overall survival. Secondary endpoints included PCa-specific survival. Inverse probability of treatment weighting (IPTW)-adjusted Cox proportional hazard regression and competing risk analysis were performed to assess outcomes. After IPTW-adjusting, pseudo-population comprised 521,656 men (observation: 170,428, radiotherapy: 175,628, radical prostatectomy: 175,600) at a median 36.5 month follow-up. Observation demonstrated the lowest 5-year overall survival rate (91.6%) after IPTW-adjusting in comparison to radiotherapy (92.4%) and radical prostatectomy (96.1%, p<0.001). Men who underwent radical prostatectomy had the lowest cumulative PCa-specific and all-cause mortality (p<0.001). Compared to observation, radiotherapy (sub-distribution hazard ratio [sHR], 0.89; 95% CI, 0.81-0.97; p=0.012) and radical prostatectomy (sHR, 0.46; 95% CI, 0.41-0.52; p<.001) had a lower risk of PCa-specific mortality in competing risk analysis after adjustment for all other factors and other-cause death. Intermediate-term mortality risk in men with localized PCa were lower with active treatments compared to observation-especially for intermediate- and high-risk disease. However, observation represents a safe management strategy in men within the low-risk group.

Management and outcome of post-myocardial infarction ventricular septal rupture-A Low-Middle-Income Country Experience.

Ventricular septal rupture (VSR) is a rare complication after acute myocardial infarction (AMI) especially in the reperfusion era but its associated mortality has remained high. This case series evaluated in-hospital and intermediate-term mortality in VSR patients. Additionally, we also analyzed risk factors, clinical presentation, intervention, and predictors of in-hospital mortality in VSR patients. Data of 67 patients with echocardiography confirmed diagnosis of VSR from January 2011 to April 2020 was extracted from hospital medical records. Records were also reviewed to document 30 day and 1-year mortality, recurrent heart failure admission, repeat myocardial infarction, and revascularization. In addition, telephonic follow-up was done to assess health-related quality of life(HRQOL) assessed by KCCQ-12. SCAI shock classification was used to categorize severity of cardiogenic shock. Univariate and multivariable logistic regression was used to determine predictors of in-hospital mortality. Survival function was presented using the Kaplan-Meier survival curve. Mean age of patients was 62.7 ± 11.1 years, 62.7% were males. 65.7% of the patients presented more than 24 hours after MI and did not receive reperfusion therapy. Median time from AMI to VSR diagnosis was 2 (1-5) days. VSR closure was attempted in 53.7% patients. In-hospital mortality was 65.7%. At univariate level, predictors of in-hospital mortality were non-surgical management, basal VSR, right ventricular dysfunction, early VSR post-MI, and severe cardiogenic shock at admission (class C, D, or E). Adjusted predictors of in-hospital mortality included non-surgical management, basal VSR and advanced cardiogenic shock. There were 5 deaths during median followup of 44.1 months. HRQOL in patients available on followup was good (54.5%) or excellent (45.5%). High in-hospital mortality was seen in VSR patients. VSR closure is the preferred treatment to get long-term survival, however, timing of repair as well as severity of cardiogenic shock plays a significant role in determining prognosis.

Assessment of Intermediate-Term Mortality after Pancreatectomy: Implications for Informed Consent and Shared Decision-Making

Assessment of Intermediate-Term Mortality after Pancreatectomy: Implications for Informed Consent and Shared Decision-Making

Female patients with coronary artery disease and aortic stenosis undergoing a surgical or interventional treatment in terms of revascularization and valve replacement

Abstract Background Coronary artery disease (CAD) in female patients undergoing a Transcatheter Aortic Valve Implantation (TAVI) is accompanied with a worse outcome compared to those without CAD. Nevertheless, it is still unclear whether a complete revascularization and outcome are achieved similarly in women treated with an interventional (PCI plus TAVI) or surgical (CABG plus SAVR) treatment strategy. Purpose This study aims to compare the completeness of revascularization in terms of residual SyntaxScore and to evaluate the differences in 30-days (short-term), one-year and three-years (intermediate term) mortality in women with CAD and AS undergoing a surgical or catheter-based treatment. Methods Patients were recruited at one tertiary center in Germany between 2016 and 2019. Initially the surgical group contained 932 patients and the interventional cohort 360 patients as a result of setting a maximum time interval of 3 months between PCI and TAVI. The surgical group (CABG+SAVR) and the interventional group (PCI+TAVI) were compared by using a propensity score analysis. Age, left ventricular function, EuroSCORE II and degree of CAD served as matching parameters so that the matched female cohort finally consisted of 114 patients (57 patients treated interventionally, 57 treated surgically). Syntax Score was measured before and after revascularization. As a primary endpoint all-cause mortality was analyzed at 30 days, one and three years after the procedure. Results Median age was 80 years both in the interventional and surgical cohort (p=0.298). Both groups represented a moderate to high-risk population (EuroScore II in PCI+TAVI: 4.39 [2.83–8.82] vs 6.18 [3.43–8.6] in CABG+SAVR (p=0.279) and showed no significant difference in median pre-interventional/preoperative SyntaxScore I (PCI+TAVI: 16.00 [9–26.5] vs CABG+SAVR: 18 [9.5–25.5]; p=0.719). In the interventional group coronary physiology was measured more frequently (6.8% vs 1.8%, p=0.024). There was no significant difference in the presence of an aortoostial lesion, heavy calcification and a length of the lesion &amp;gt;20mm between PCI+TAVI and CABG+SAVR before therapy (PCI+TAVI vs CABG+SAVR: 11.1% vs 13.0%, p=0.581; 60.5% vs 55.1%, p=0.289; 20.4% vs 25.1%, p=0.316). The main stem as target lesion was present in both groups with no significant difference (PCI+TAVI vs CABG+SAVR: 8.8% vs 19.3%, p=0.106). Median residual SyntaxScore I was significantly higher in PCI+TAVI than in CABG+SAVR (5.0 [0.0–13.0] vs 0.0 [0.0–8.5], p=0.03). No significant difference in 30-days, 1-year and 3-years mortality was observed between the interventional and surgical group (PCI+TAVI vs CABG+SAVR: 3.5% vs 8.8%, p=0.242; 10.5% vs 14%, p=0.568; 22.8% vs 15.8%, p=0.342). Conclusion Female patients with AS and CAD with low SyntaxScore undergoing CABG+SAVR reach a more complete revascularization than those treated interventionally. Nevertheless, this fact seems to have no influence on short and intermediate term mortality. Funding Acknowledgement Type of funding sources: None.

Robotic-assisted tracheobronchoplasty: Quality of life and pulmonary function assessment on intermediate follow-up.

Robotic-assisted tracheobronchoplasty: Quality of life and pulmonary function assessment on intermediate follow-up.

Surgical treatment on infective endocarditis: impact of diabetes on mortality

BackgroundType 2 diabetes mellitus (DM) is a frequent co-morbidity among patients suffering from infective endocarditis (IE). The aim of the study was to evaluate the impact of type 2 DM on the early-, intermediate- and long-term mortality of patients who underwent surgical treatment of endocarditis.MethodsWe performed an observational cohort study in the large tertiary center in Israel during 14 years. All data of patients who underwent surgical treatment of endocarditis, performed between 2006 and 2020 were extracted from the departmental database. Patients were divided into two groups: Group I (non-diabetic patients), and Group II (diabetic patients).ResultsThe study population includes 420 patients. Group I (non-diabetic patients), comprise 326 patients, and Group II (diabetic patients), comprise 94 patients. Mean follow-up duration was 39.3 ± 28.1 months. Short-term, 30-day and in-hospital mortality, also intermediate-term mortality (1- and 3-year) was higher in the DM group compared with the non-DM group, but did not reach statistical significance: 11.7% vs. 7.7%. (p = 0.215); 12.8% vs. 8.3% (p = 0.285); 20.2% vs. 13.2% (p = 0.1) and 23.4% vs. 15.6% (p = 0.09) respectively. Long-term, 5-year mortality was significantly higher in the DM group, compared to the non-DM group: 30.9% vs. 16.6% (p = 0.003). Furthermore, predictors for long-term mortality included diabetes (CI 1.056–2.785, p = 0.029), as demonstrated by regression analysis.ConclusionsDiabetic patients have trend to increasing mortality at the short- and intermediate period post-surgery for IE, but this is not statistically significant. Survival of diabetic patients deteriorates after more than three years follow surgery. Diabetes is an independent predictor for long-term, 5-year mortality after surgical treatment of endocarditis, regardless of the patients age and comorbidities.Trial registration Ethical Committee of Sheba Medical Centre, Israel on 02.12. 2014, Protocol 4257

Diagnostic approaches to syncope in Internal Medicine Departments and their effect on mortality

Diagnostic approaches to syncope in Internal Medicine Departments and their effect on mortality

Sequential organ failure assessment score improves survival prediction for left ventricular assist device recipients in intensive care.

Preoperative risk scores facilitate patient selection, but postoperative risk scores may offer valuable information for predicting outcomes. We hypothesized that the postoperative Sequential Organ Failure Assessment (SOFA) score would predict mortality after left ventricular assist device (LVAD) implantation. We retrospectively reviewed data from 294 continuous-flow LVAD implantations performed at Mayo Clinic Rochester during 2007 to 2015. We calculated the EuroSCORE, HeartMate-II Risk Score, and RV Failure Risk Score from preoperative data and the APACHE III and Post Cardiac Surgery (POCAS) risk scores from postoperative data. Daily, maximum, and mean SOFA scores were calculated for the first 5 postoperative days. The area under receiver-operator characteristic curves (AUC) was calculated to compare the scoring systems' ability to predict 30-day, 90-day, and 1-year mortality. For the entire cohort, mortality was 5% at 30 days, 10% at 90 days, and 19% at 1 year. The Day 1 SOFA score had better discrimination for 30-day mortality (AUC 0.77) than the preoperative risk scores or the APACHE III and POCAS postoperative scores. The maximum SOFA score had the best discrimination for 30-day mortality (AUC 0.86), and the mean SOFA score had the best discrimination for 90-day mortality (AUC 0.82) and 1-year mortality (AUC 0.76). We observed that postoperative mean and maximum SOFA scores in LVAD recipients predict short-term and intermediate-term mortality better than preoperative risk scores do. However, because preoperative and postoperative risk scores each contribute unique information, they are best used in concert to predict outcomes after LVAD implantation.

The impact of diabetes on short-, intermediate- and long-term mortality following left ventricular assist device implantation.

Type 2 diabetes mellitus (DM) is a frequent comorbidity among patients suffering from advanced heart failure necessitating a left ventricular assist device (LVAD) implant. The goal of this study was to evaluate the impact of type 2 DM on early and long-term outcomes of patients following an LVAD implant. We performed an observational cohort study in a large tertiary care centre in Israel. All data of patients who underwent a continuous flow LVAD implant between 2006 and 2020 were extracted from our departmental database. Patients were divided into 2 groups: group I (patients without diabetes) and group II (patients with diabetes). We compared short-term (30-day and 3-month) mortality, intermediate-term (1- and 3-year) mortality and long-term (5 year) mortality between the 2 groups. The study population included 154 patients. Group I (patients without diabetes) comprised 88 patients and group II (patients with diabetes) comprised 66 patients. The mean follow-up duration was 38.2 ± 30.3 months. Short- and intermediate-term mortality (30 days, 1 year and 3 years) was higher in the group with DM compared with the group without DM but did not reach any statistically significant difference: 16.1% vs 9.8% (P = 0.312), 24.2% vs 17.3% (P = 0.399) and 30.6% vs 21.9% (P = 0.127) respectively. Long-term 5-year mortality was significantly higher in the group with DM compared to the group without: 38.7% vs 24.4% (P = 0.038). Furthermore, predictors of long-term mortality included diabetes (hazard ratio 2.09, confidence interval 1.34-2.84, P = 0.004), as demonstrated by regression analysis. Patients with diabetes and those without diabetes have similar 30-day and short- and intermediate-term mortality rates. The mortality risk of diabetic patients begins to increase 3 years after an LVAD implant. Diabetes is an independent predictor of long-term, 5-year mortality after an LVAD implant. Ethical Committee of Sheba Medical Centre, Israel, on 2 December 2014, Protocol 4257.

468. Delayed Mortality Among Solid Organ Transplant Recipients Hospitalized for Covid-19: An International Multicenter Study

Abstract Background Studies of solid organ transplant recipients (SOTr) hospitalized for Covid-19 have focused on short-term outcomes with approximately 30 days of follow-up time. Intermediate-term mortality and associated risk factors for intermediate-term death have not previously been reported. Methods Using data from a multi-center registry, we assessed mortality by 90 days among SOTr hospitalized for Covid-19 between 3/1/2020 and 12/31/2020. Multivariable Cox-proportional hazard models were used to compare risk factors for mortality by 28 and 90 days. Covariates were selected a priori based on known predictors of death in SOTr hospitalized for Covid-19. All patients were followed for 90 days or were censored at the time of death or last clinical contact, if this occurred prior to day 90 after diagnosis. Results Among SOTr hospitalized for Covid-19, 198/979 (20%) died within 90 days of diagnosis and 37/198 (19%) of deaths occurred between days 29 and 90. Risk factors for mortality by day 90 days included age &amp;gt;65 years (1.8, 95% CI 1.3-2.4, P&amp;lt; 0.001), lung transplant (compared to non-lung) (1.6, 95% CI 1.1-2.4, P=0.02), chronic lung disease (2.2, 95% CI 1.5-3.4, P=0.002) and heart failure (1.9, 95% CI 1.2-2.9), which were similar to risk factors reported for 28-day mortality (Table 1). Diagnosis during the second half of 2020 (6/20-12/31/20) was associated with lower mortality by 28 days (aHR 0.7, 95% CI 0.5-1.0, P=0.03) compared to diagnosis during the early half of 2020 (3/1-6/19/20); however, mortality by 90 days was similar in the late and early time periods (aHR 0.9, 95% CI 0.7-1.2, P=0.54). Obesity and mTOR inhibitor use were also associated with death by 28 but not 90 days. Kaplan-Meier survival curves by time period of diagnosis are shown in Figure 1. Table 1. Multivariable Cox-Proportional Hazard Model for Mortality at 28 and 90-days Among Solid Organ Transplant Recipients Hospitalized for Covid-19 (N=979) Figure 1. Survival among SOT recipients hospitalized for Covid-19 by diagnosis time period Vertical tick marks represent censored cases. Early 2020 refers to cases diagnosed between March 1 and June 19, 2020 and late 2020 refers to cases diagnosed between June 20 and December 31, 2020. Conclusion Approximately 20% of deaths among SOTr hospitalized for Covid-19 occurred between days 29 and 90. Future investigations are required to discern the mechanism(s) for the improvement in early, but not late, mortality among SOTr with Covid-19 during the course of the pandemic. Disclosures Madeleine R. Heldman, MD, Cigna Lifesource (Other Financial or Material Support, Speaking honoraria)Thermo Fisher Scientific (Other Financial or Material Support, Speaking honoraria) Olivia S. Kates, MD, Merk (Scientific Research Study Investigator) Ajit P. Limaye, MD, astellas (Scientific Research Study Investigator)CTI (Scientific Research Study Investigator)GSK (Consultant)Johnson&amp;Johnson (Other Financial or Material Support, Adjudication Committee)merck (Consultant, Grant/Research Support, Scientific Research Study Investigator)moderna (Scientific Research Study Investigator)Novartis (Other Financial or Material Support, DMC member)Novo Nordisk (Consultant)