Month Mortality In Patients Research Articles

Comparison of prognostic value of sarcopenia and meld score in assessing 28 days and 3 months mortality in patients with cirrhosis of liver

Comparison of prognostic value of sarcopenia and meld score in assessing 28 days and 3 months mortality in patients with cirrhosis of liver

Development and Internal Validation of a Multivariable Prediction Model for Mortality After Hip Fracture with Machine Learning Techniques

In order to estimate the likelihood of 1, 3, 6 and 12 month mortality in patients with hip fractures, we applied a variety of machine learning methods using readily available, preoperative data. We used prospectively collected data from a single university hospital in Copenhagen, Denmark for consecutive patients with hip fractures, aged 60 years and older, treated between September 2008 to September 2010 (n = 1186). Preoperative biochemical and anamnestic data were used as predictors and outcome was survival at 1, 3, 6 and 12 months after the fracture. After feature selection for each timepoint a stratified split was done (70/30) before training and validating Random Forest models, extreme gradient boosting (XGB) and Generalized Linear Models. We evaluated and compared each model using receiver operator characteristic (ROC), calibration slope and intercept, Spiegelhalter’s z- test and Decision Curve Analysis. Using combinations of between 10 and 13 anamnestic and biochemical parameters we were able to successfully estimate the likelihood of mortality with an area under the curve on ROC curves of 0.79, 0.80, 0.79 and 0.81 for 1, 3, 6 and 12 month, respectively. The XGB was the overall best calibrated and most promising model. The XGB model most successfully estimated the likelihood of mortality postoperatively. An easy-to-use model could be helpful in perioperative decisions concerning level of care, focused research and information to patients. External validation is necessary before widespread use and is currently underway, an online tool has been developed for educational/experimental purposes (https://hipfx.shinyapps.io/hipfx/).

Pupil reflex as a marker of activity and prognosis in heart failure: a longitudinal and prospective study.

Compensatory mechanisms in heart failure (HF) are triggered to maintain adequate cardiac output. Among them, hyperactivation of the sympathetic nervous system (SNS) is one of the main ones and carries a worse prognosis. The pupillary reflex depends on the SNS, and we can evaluate it through pupillometry. The aim of the study was to compare the differences in pupillary reflex between patients with acute HF and controls and to analyse whether these differences in pupillary reflex may offer a new and easy prognostic factor in such patients. We prospectively and consecutively included 107 patients admitted with decompensated HF. Quantitative pupillometry was performed with the NeuroOptics pupillometry during the first 24h after admission and prior to discharge. The results were compared with those of a group of 100 healthy volunteers who also underwent pupillometry. The maximum baseline pupil size (MBPS) and the minimum pupil diameter (MPD) were measured. Patients with decompensated HF have a higher MBPS (3.64±0.81) and higher MPD (2.60±0.58) than HF patients at discharge and in the control group (P-value=0.01 and 0.01, respectively). Also, HF patients presented an improvement in pupillometric values at discharge [MBPS (3.47±0.79) and MPD (2.51±0.58)] and showed no differences compared with the control group [MBPS (3.34±0.82) and MPD (2.40±0.53)] (P-value=0.19 and 0.14, respectively). In addition, MBPS provides a good independent predictor of in-hospital and 1month mortality in patients admitted with HF. Six patients (5.61%) died during hospital admission, and 11 patients (10.2%) died in the first month after discharge. Also, four patients (3.74%) were readmitted within 1month of discharge. The receiver operating characteristic (ROC) curve for predicting in-hospital mortality through MBPS was 0.823. No patient with an MBPS<3.7mm died. The ROC curve for predicting combined mortality or readmission within the first month for MBPS was 0.698. Pupillometry may be a new, non-invasive, and simple tool to determine the status of SNS, help in the prognostic stratification of acute HF patients, and improve therapeutic management.

WED-363 - Comparison of prognostic value of sarcopenia and MELD score in assessing 28 days and 3 months mortality in patients with cirrhosis of liver

WED-363 - Comparison of prognostic value of sarcopenia and MELD score in assessing 28 days and 3 months mortality in patients with cirrhosis of liver

QSOFA Score is useful to predict in-hospital mortality and long-term outcomes in patients with acute coronary syndrome

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Quick Sequential Organ Failure Assessment (qSOFA) is a bedside score widely used to identify patients at greater risk for a poor outcome outside the intensive care unit. Initially applied in patients with suspected infection, the score has recently emerged as a marker for poor prognosis or mortality across various patient groups. Aim To validate the qSOFA score as a predictor of in-hospital mortality and long-term outcomes in acute coronary syndrome (ACS) patients. Methods A retrospective analysis of 1296 patients admitted for ACS was performed. qSOFA score evaluates the presence of 3 variables: systolic blood pressure &amp;lt;120mmHg (1 point), respiratory rate ≥22 breaths per min (1 point), and Glasgow coma scale &amp;lt;15 (1 point). The score derived from these variables allowed the classification of patients into two risk categories: low risk (LR) (&amp;lt;2 points) and high risk (HR) (≥2 points). The Mann-Whitney U test was used for median comparison between groups. In addition, Kaplan-Meier survival plot was used to evaluate the predictive power of qSOFA score on in-hospital mortality and 12-month mortality (12MM). Results Mean age 69,1±13years; 70% were male. The mean time of hospitalization was 7,4±5days. 34% had a diagnosis of ST-elevation myocardial infarction (STEMI). Mean left ventricular ejection fraction (LVEF) was 56,4±14,6%. Global in-hospital mortality was 8%. qSOFA was calculated, and the population was divided into 2 groups: 78% had low risk (qSOFA &amp;lt;2) and 6% had high risk (qSOFA ≥2). HR group defined by qSOFA was significantly associated with in-hospital mortality (28% vs 8%; p&amp;lt;0,01, OR: 3,8 CI 95% 2,4;6,2). Kaplan-Meier survival analysis revealed that HR qSOFA was significantly associated with 12MM (p&amp;lt;0,01; 24% vs 7%; 260 vs 321 days until event, χ2 8,2). In logistic regression analysis, LVEF and diagnosis of STEMI did not increase the risk of a higher qSOFA score and in-hospital mortality (p=0,06 and p=0,94). HR group is significantly associated with left main coronary artery disease (12% vs 9%; p&amp;lt;0,01; OR 2,4; CI 95% 1,2;4,9) and in-hospital complications, including arrhythmia, mechanical complications, hemorrhagic events, acute kidney disease and hematological disorders (54% vs 28%; p&amp;lt;0,01; OR 3,0; CI 95% 1,9;4,6). Conclusion qSOFA score is associated with higher in-hospital mortality and 12 month-mortality in patients with ACS. Its use may identify patients with an increased risk of mortality, needing specialized care, and a close follow-up.

Frequency and Outcomes of Hepatorenal Syndrome in Patients with Chronic Liver Disease

Objective: To determine the frequency of hepatorenal syndrome in patients presented with chronic liver disease, also examine one month mortality in patients diagnosed with hepatorenal syndrome. Study Design: Prospective/Observation Study Place and Duration: Medical Ward, THQ Hospital Dargai Malakand and Ziauddin University Karachi, From November, 2021 to April, 2022. Methodology: One hundred and five patients of either gender presented with chronic liver disease having ages 18 to 65 years were enrolled. Detailed demographics including age, sex, BMI, duration of disease and etiology of liver cirrhosis were recorded after taking informed written consent. Patients with hepatic encephalopathy being treated with nephrotoxic drugs, acute infection, hypovolemia, sepsis, and fulminant and sub-fulminant hepatic failure were excluded. Serum creatinine was analyzed in all the patients to examine renal failure. Outcomes in term of one month mortality was also examined in HRS patients. Data was analyzed by SPSS 24.0. Results: There were 63 (60%) males while 42 (40%) patients were females with mean age 47.18±11.64 years. Mean BMI was 24.66±3.84 kg/m2. Among 105 patients 15 (14.29%) patients were diagnosed to have hepatorenal syndrome. Out of 15 HRS patients, 4 (26.67%) were died. Conclusion: It is concluded that frequency of hepatorenal syndrome in liver cirrhosis patients was high. And HRS was associated with high rate of mortality. Keywords: Chronic Liver Disease, HBV, HCV, Hepatorenal Syndrome, Mortality

Relation of Volume of Hemorrhage With Mortality Within First 48 Hours in Hemorrhagic Stroke

Background: Hemorrhagic stroke accounts for 10-15% of all strokes with higher mortality rates than cerebral infarction. Intracerebral hemorrhage has a reported 30-day mortality of 44% to 51%, with almost half of the death occurs within the first 48 hours. Advanced age, low level of consciousness, large volume of hemorrhage has been linked with poor outcome. Objectives: To predict early outcome of hemorrhagic stroke patient in relation with age, Glasgow Coma Scale, volume of hemorrhage and ventricular extension. Materials and Methods: Hospital based prospective study carried out in hundred hemorrhagic stroke patients. The formula of ABC/2 was used to calculate hemorrhage volume in bedside by using CT scan. Results: 1st month mortality rates of hemorrhagic stroke was 44% with 45.45% of patients died within the first 48 hours of onset. Mean age of patients of hemorrhagic stroke was 61.2 ± 13.88 years. Mortality rate of intracerebral hemorrhage after age of 60 was 51.06% in 1st month. Volume of intracerebral hemorrhage was the strongest predictor of both 48 hours and 30 days mortality. Using three categories of intracerebral hemorrhage (X for &lt; 30 ml, Y for 30 - 50 ml and Z for &gt; 50 ml group) calculated by ABC/2 formula showed 100% mortality rate in Z group, 50% in Y group and only 12% mortality rate in X group in 1st month. Among all death, 61.5% of Z group 25% of Y group and 16.67% of patients of X group died within 48 hours. Two categories of Glasgow Coma Scale (≤ 8 and ≥ 9) were used and shown death rates 80.77% in GCS ≤ 8 and 4.55% in GCS ≥ 9 in 1st month. Conclusion: Volume of intracerebral hemorrhage in combination with advanced age, initial Glasgow Coma Scale is a powerful and easy to use in both 48 hours and 1st month mortality in patients with spontaneous intracerebral hemorrhage. KYAMC Journal. 2021;12(3): 127-132

Six Month Mortality in Patients with COVID-19 and Non-COVID-19 Viral Pneumonitis Managed with Veno-Venous Extracorporeal Membrane Oxygenation.

A significant proportion of patients with COVID-19 develop acute respiratory distress syndrome (ARDS) with high risk of death. The efficacy of veno-venous extracorporeal membrane oxygenation (VV-ECMO) for COVID-19 on longer-term outcomes, unlike in other viral pneumonias, is unknown. In this study, we aimed to compare the 6 month mortality of patients receiving VV-ECMO support for COVID-19 with a historical viral ARDS cohort. Fifty-three consecutive patients with COVID-19 ARDS admitted for VV-ECMO to the Royal Brompton Hospital between March 17, 2020 and May 30, 2020 were identified. Mortality, patient characteristics, complications, and ECMO parameters were then compared to a historical cohort of patients with non-COVID-19 viral pneumonia. At 6 months survival was significantly higher in the COVID-19 than in the non-COVID-19 viral pneumonia cohort (84.9% vs. 66.0%, p = 0.040). Patients with COVID-19 had an increased Murray score (3.50 vs. 3.25, p = 0.005), a decreased burden of organ dysfunction (sequential organ failure score score [8.76 vs. 10.42, p = 0.004]), an increased incidence of pulmonary embolism (69.8% vs. 24.5%, p < 0.001) and in those who survived to decannulation longer ECMO runs (19 vs. 11 days, p = 0.001). Our results suggest that survival in patients supported with EMCO for COVID-19 are at least as good as those treated for non-COVID-19 viral ARDS.

Intracranial pressure monitoring in patients with acute brain injury in the intensive care unit (SYNAPSE-ICU): an international, prospective observational cohort study

The indications for intracranial pressure (ICP) monitoring in patients with acute brain injury and the effects of ICP on patients' outcomes are uncertain. The aims of this study were to describe current ICP monitoring practises for patients with acute brain injury at centres around the world and to assess variations in indications for ICP monitoring and interventions, and their association with long-term patient outcomes. We did a prospective, observational cohort study at 146 intensive care units (ICUs) in 42 countries. We assessed for eligibility all patients aged 18 years or older who were admitted to the ICU with either acute brain injury due to primary haemorrhagic stroke (including intracranial haemorrhage or subarachnoid haemorrhage) or traumatic brain injury. We included patients with altered levels of consciousness at ICU admission or within the first 48 h after the brain injury, as defined by the Glasgow Coma Scale (GCS) eye response score of 1 (no eye opening) and a GCS motor response score of at least 5 (not obeying commands). Patients not admitted to the ICU or with other forms of acute brain injury were excluded from the study. Between-centre differences in use of ICP monitoring were quantified by using the median odds ratio (MOR). We used the therapy intensity level (TIL) to quantify practice variations in ICP interventions. Primary endpoints were 6 month mortality and 6 month Glasgow Outcome Scale Extended (GOSE) score. A propensity score method with inverse probability of treatment weighting was used to estimate the association between use of ICP monitoring and these 6 month outcomes, independently of measured baseline covariates. This study is registered with ClinicalTrial.gov, NCT03257904. Between March 15, 2018, and April 30, 2019, 4776 patients were assessed for eligibility and 2395 patients were included in the study, including 1287 (54%) with traumatic brain injury, 587 (25%) with intracranial haemorrhage, and 521 (22%) with subarachnoid haemorrhage. The median age of patients was 55 years (IQR 39-69) and 1567 (65%) patients were male. Considerable variability was recorded in the use of ICP monitoring across centres (MOR 4·5, 95% CI 3·8-4·9 between two randomly selected centres for patients with similar covariates). 6 month mortality was lower in patients who had ICP monitoring (441/1318 [34%]) than in those who were not monitored (517/1049 [49%]; p<0·0001). ICP monitoring was associated with significantly lower 6 month mortality in patients with at least one unreactive pupil (hazard ratio [HR] 0·35, 95% CI 0·26-0·47; p<0·0001), and better neurological outcome at 6 months (odds ratio 0·38, 95% CI 0·26-0·56; p=0·0025). Median TIL was higher in patients with ICP monitoring (9 [IQR 7-12]) than in those who were not monitored (5 [3-8]; p<0·0001) and an increment of one point in TIL was associated with a reduction in mortality (HR 0·94, 95% CI 0·91-0·98; p=0·0011). The use of ICP monitoring and ICP management varies greatly across centres and countries. The use of ICP monitoring might be associated with a more intensive therapeutic approach and with lower 6-month mortality in more severe cases. Intracranial hypertension treatment guided by monitoring might be considered in severe cases due to the potential associated improvement in long-term clinical results. University of Milano-Bicocca and the European Society of Intensive Care Medicine.

SUN-PO212: Prognostic Impact of Hand Grip Strength Compared to Calf Circumference for Predicting 6 Month Mortality in Patients Undergoing Abdominal Surgery

SUN-PO212: Prognostic Impact of Hand Grip Strength Compared to Calf Circumference for Predicting 6 Month Mortality in Patients Undergoing Abdominal Surgery

Comparison of efficacy of surgery and conservative treatment for patients with critical spontaneous deep supratentorial intracerebral hemorrhage

Objective To study and compare the efficacy of surgery and conservative treatments for patients with critical (30 to 50 ml) spontaneous deep supratentorial intracerebral hemorrhage. Methods The clinical data of 420 patients diagnosed as spontaneous deep supratentorial intracerebral hemorrhage in Affiliated Hospital of Yan′an and Central Hospital of Baoji from August 2011 to September 2016 in this study were retrospectively analyzed. All patients were divided into surgery group (210 cases) and conservative group (210 cases) according to the difference of treatment methods. Large trauma craniotomy was used by the operation group, external ventricular drainage as the standby in necessary. The treatment of conservative group mainly included reduction of intracranial pressure, blood pressure management, prevention of complications and other individualized treatment. The primary outcome was neurological functional status of patients at 6 months of discharging, and the secondary outcomes included the mortality at 1 month and 6 months of discharging, and complications. Continuous data were presented as ±s and were compared using the t test, while categorical data were presented as number and percentage and were compared using the χ2 test. Results No obvious difference on mRS score and NIHSS score occurred between two groups (All P>0.05). Stratified analysis, patients with midline shift >5 mm and with intraventricular hemorrhage were more likely to have a favorable outcome from surgery compared with conservative group (18.2% vs. 8.1%, χ2=4.099, P=0.043; 17.3% vs. 5.0%, χ2=4.836, P=0.028). The mortality at 1 month days and 6 months in surgery group were significantly lower than that in conservative group (19.0% vs. 31.0%, χ2=7.937, P=0.005; 23.8% vs. 36.7%, χ2=8.228, P=0.004). Meanwhile, the incidence of pulmonary infection and with long-term pipe in surgery group were significantly higher than those in conservative group (31.9% vs. 15.7%, χ2=15.173, P=0.000; 28.6% vs. 19.5%, χ2=4.706, P=0.030). Conclusion Surgery can reduce the 1 month and 6 months mortality in patients with spontaneous deep supratentorial hemorrhage and improve the functional outcomes in patients with large midline shift or with intraventricular hemorrhage compared with conservative treatment. Key words: Cerebral hemorrhage; Surgical procedures, operative; Spontaneous deep supratentorial intracerebral hemorrhage; Treatment outcome; Conservative treatment

Higher Mortality in Patients with Coronary Artery Disease and Gastrointestinal Bleeding While on Dual Antiplatelet Therapy with Oral Anticoagulants

Introduction: For patients with coronary artery disease (CAD) on aspirin (ASA), risk of gastrointestinal bleeding (GIB) increases significantly in those requiring dual antiplatelet therapy (DAPT) and a vitamin K antagonist (known as triple therapy). Outcomes of patients with CAD and GIB while on triple therapy compared to ASA alone are unknown. Our objective was to compare the post-discharge mortality for patients on triple therapy compared to ASA alone in a subset of patients with CAD hospitalized with lower GIB.Table 1: Patient Characteristics Associated with Triple Therapy UseTable 2: Multivariate Logistic Regression of Risk Factors Associated with 6 Month MortalityMethods: Using a validated ICD-9 classification tree with a priori sensitivity and specificity of 92.3% for identifying patients with lower GIB, 716 patients were identified with CAD and use of aspirin admitted to an academic tertiary medical center from 2008-2015 with a lower GIB. ICD-9 codes were utilized to identify co-morbidities, while demographics, labs and medications were extracted from the medical record. Patients dying during index hospitalization were excluded from the analysis. Mortality data was linked to social security death indices. Univariate and multivariate logistic regression was used to evaluate the association between triple therapy use in CAD patients and 6 month mortality. Results: 716 patients with CAD were admitted with a lower GIB while on ASA. 9% (n=65) were on triple therapy at index admission. Patients on triple therapy had a higher prevalence of congestive heart failure (72.3% vs 53.0%, p=0.004), atrial fibrillation (43.1% vs 28.4%, p= 0.01, and were more likely to require blood transfusion (57.0% vs. 35.8%, p < 0.001). 9.7 % (n=70) died within 6 months of discharge after lower GIB. Use of triple therapy at index GIB was associated with an increased 6 month odds of mortality on univariate analysis (OR 2.61, 95%CI 1.29-4.94), as was malignancy (OR 2.98 95%CI 1.72-5.08) and higher Charlson index (OR 1.22, 95%CI 1.12-1.32). On multivariate analysis adjusted for age, comorbidity, admission hemoglobin, ICU needs, congestive heart failure, and malignancy, use of triple therapy remained associated with increased 6 month mortality risk (OR 2.55, 95% CI 1.29-4.95). Conclusion: Use of triple therapy with dual antiplatelet and oral anticoagulation is associated with higher 6 month mortality in patients with CAD and GIB.

Predictors of Mortality at 3 Months and 6 Months Excluding 1 Month Mortality in Patients with Acute on Chronic Liver Failure (ACLF)—A Single Centre Experience

Background and Aim: Acute on Chronic Liver Failure (ACLF) is a newly described clinical entity. Most of the studies assess the 28 days mortality with SOFA, MELD and CTP scores correlating with outcome. We have taken only those patients who survived the first 1 month. Our aim was to analyse the different variables and assess the predictors of mortality. Methods: This is a retrospective single centre cohort study from the department of Medical Gastroenterology Medical College Thiruvananthapuram (January 2012–December 2014). All consecutive patients satisfying the APASL criteria and surviving for more than one month were taken for analysis. Results: Of the 101 patients, 83.2% were males with mean age 46.6 years. Ascites present in all with 35.6% having Spontaneous bacterial peritonitis. The major chronic aetiologies were alcohol (60.4%) and hepatitis B (19.8%). The acute insults were single in 73.3% and multiple in others. The major acute insults were alcoholic hepatitis (52.5%) and chronic hepatitis B flare (14.9%). The observed mortality at 3 months and 6 months were 21.4% and 32.1% respectively. Neither the acute insult nor the chronic aetiology had significant association with outcome. But the presence of multiple acute insults correlated with outcome at 3 months (P = 0.032). By ROC analysis, predictor of mortality at 3 months was age (P = 0.025) with cut off 45.8 years. The predictors of mortality at 6 months were age (P = 0.002) with cut off 47.5 years. Serum sodium level associated with mortality at 6 months only (P = 0.009) with cut off 132.5. Conclusion: In this single centre study, the mortality was 21.4% at 3 months and 32.1% at 6 months excluding the first month mortality. At 3 months, age >45.8 years correlated with worst outcome. At 6 months age >47.5 years and serum sodium level <132.5 correlated with mortality. The authors have none to declare.

45 Frailty at Discharge is a Marker of End-of-Life following Admission with Acute Coronary Syndrome or Acute Heart Failure

Background Patients with advanced heart disease who are approaching end-of-life (EoL) rarely receive palliative care. This study evaluated the utility of the Canadian Study of Health and Ageing Clinical Frailty Scale (CFS) in predicting 12 month mortality in patients discharged from hospital following acute coronary syndrome (ACS) or acute heart failure (AHF). Methods 188 unselected consecutive patients admitted to an acute cardiology ward over a 8 week period with either ACS or AHF were assessed prior to discharge using a number of prognostic tools including CFS, GRACE (for ACS), EFFECT (for AHF) and the Gold Standards Framework (GSF) prognostic indicator guide. Unscheduled hospital admissions and all-cause mortality were then documented over a 12 month period of follow-up. Results The presence of frailty (CFS 5–7) had a high sensitivity (83%) and specificity (79%) in predicting 12 month mortality for both ACS and AHF patients. Compared to GSF, the CFS was more sensitive and had higher positive predicting value for 12-month mortality (C–statistic 0.81). The addition of the GRACE or EFFECT score to CFS improved its predictive value only marginally. (C-statistic 0.83). No clear relationship was identified between frailty and risk of unscheduled hospital admissions during follow-up. Conclusion CFS could be used in combination with a disease-specific clinical score (GRACE or EFFECT) at time of discharge from hospital to identify ACS and AHF patients at increased risk of death within 12 months and who may therefore be suitable for end-of-life care.

Abstract 16235: The Impact of Atrial Fibrillation on Heart Failure With Preserved versus Reduced Ejection Fraction in the Middle East Region: Insights From the Gulf aCute heArt failuRe rEgistry (Gulf CARE)

Background: Atrial Fibrillation (AF) and heart failure (HF) are two common prevalent conditions that may present independent of each other or coexist. The impact of AF on mortality in patients with HF and reduced (HFrEF) or preserved ejection fraction (HFpEF) is unclear with conflicting results. Methods: We analyzed data from the Gulf acute HF registry, a prospective, multinational registry of patients admitted with acute HF in 47 hospitals in 7 Middle Eastern Arab Gulf countries (recruited between February 13, 2012 and November 13, 2012). We compared the 12-month mortality in patients with AF versus sinus rhythm (SR) in both types of HF (HFrEF and HFpEF). Results: Among 5005 patients admitted with HF, 835 patients (16.7%) had AF and 3964 (79.2 %) had no history of AF and were in SR. Remaining percentage included patients with rhythms other than AF or SR (e.g. junctional rhythm). After excluding patients with no available echocardiography and those with other rhythms, the number of patients in our study population was 4394 patients where 770 patients (17.5 %) were in the AF group ( 10.2% with HFrEF and 7.3% with HFpEF) and 3624 patients (82.5 %) were in the SR group (56.2% with HFrEF and 26.3% with HFpEF). The mortality at 12 month was significantly higher in the AF compared to SR group (21.1% vs. 16.3%; P = 0.001), even after covariate adjustment (odds ratio [OR] = 1.23, 95% C.I 1.01-1.5; P = 0.04). Furthermore, subgroup analysis revealed that AF was associated with a higher risk of 12 month mortality in patients with HFrEF (23.7% vs. 16.6%; P = 0.001) but not among patients with HFpEF (17.5% vs. 15.8%; P = 0.48), even after covariate adjustment (adjusted OR among patients with HFrEF = 1.40, 95% C.I. 1.10-1.80; P=0.009 while adjusted OR among patients with HFpEF = 0.93. 95% C.I.:0.65 - 1.32; P=0.67). Conclusion: AF is associated with significantly higher 12-month mortality among patients with HFrEF, but not among those with HFpEF, suggesting a stronger impact of AF in patients with systolic HF.

TCT-220 Impact of chronic total occlusion localization on 12-month mortality in patients with non-ST segment elevation myocardial infarction treated with percutaneous coronary intervention

The aim of the present study was to evaluate the effect of chronic total occlusion (CTO) localization in nonifarct-related artery (IRA) on 12 months mortality in patients with NSTEMI and multivessel coronary artery disease (MV CAD) treated with PCI We analyzed consecutive records of 991 patients

PWE-157 Early Tips (transjugular Intrahepatic Portosystemic Shunt) For Acute Variceal Bleeding Complicating Alcoholic Hepatitis (ah)

IntroductionThe ideal management of variceal bleeding in the setting of acute alcoholic hepatitis is unclear. We present the outcome of this subgroup of patients in a cohort of patients treated...

OC-004 In Vitro Steroid Sensitivity Accurately Predicts 6 Month Mortality in Patients with Severe Alcoholic Hepatitis

Introduction Severe alcoholic hepatitis (SAH) has a high mortality especially in those who fail to respond to steroid treatment. Early identification of steroid resistant patients may allow rapid implementation of other therapies, which may improve patient outcome. An early change in bilirubin has prognostic value but requires 7 days of steroid treatment first. Our group have previously reported that a simple 48h in vitro method for assessing steroid sensitivity (dexamethasone inhibition of lymphocyte proliferation; DILPA) correlates with 6 month mortality in patients with SAH[1]. We aimed to determine the accuracy of the DILPA in predicting outcome and to compare it to existing models of prognosis in SAH. Methods Peripheral blood was drawn from consecutive patients with a clinical diagnosis of SAH (Maddrey discriminant function [MDF] > 32). All subjects gave informed consent and ethical approval was obtained from the regional ethics committee. The primary outcome measure was 6 month mortality. Leukocytes, isolated by density gradient centrifugation, were cultured for 48h with the mitogen PHA in the presence or absence of dexamethasone. Tritiated thymidine was added for the final 6h of culture before proliferation was measured on a beta counter. Maximum suppression of lymphocyte proliferation by dexamethasone was calculated (Imax). An Imax of < 60% indicates in vitro steroid resistance as previously determined. The accuracy of the DILPA and existing scoring systems (MDF, MELD, Glasgow and Lille scores) was calculated by area under the receiver operating characteristic (AUROC). Logistic regression of baseline and day 7 parameters was performed to determine independent predictors of outcome. Results 43 patients were recruited (21% female, median age 45). Patients who survived 6 months had a significantly higher Imax than those who didn’t (79.2% v 41.7%; p = 0.0003). An Imax of > 60% had a 88% sensitivity and 78% specificity in predicting 6 month survival and an AUROC of 0.83. MDF, MELD, Glasgow and Lille scores all had lower AUROC values for predicting 6 months survival than Imax (0.36, 0.4, 0.49 and 0.61 respectively). A stepwise logistic regression demonstrated that only Imax, Day 0 albumin and change in bilirubin at Day 7 of treatment were independent predictors of 6 month survival. Conclusion The DILPA provides a simple, fast and accurate in vitro method of predicting clinical outcome in patients with SAH. This could be applied in clinical practise to identify patients who will not respond to steroid therapy within 2 days of starting treatment. Disclosure of Interest None Declared Reference 1. Di Mambro et al. Hepatology 2011;53:1316–22.

TCT-498: The Prognostic Value Of Admission Serum Creatinine for Contrast Induced Nephropathy and 12 Months Mortality In Patients with Acute ST Elevation Myocardial Infarction Underwent Primary Percutaneous Coronary Intervention

TCT-498: The Prognostic Value Of Admission Serum Creatinine for Contrast Induced Nephropathy and 12 Months Mortality In Patients with Acute ST Elevation Myocardial Infarction Underwent Primary Percutaneous Coronary Intervention

Role of aspirin in tuberculous meningitis: A randomized open label placebo controlled trial

ObjectiveTo evaluate the efficacy and safety of aspirin in preventing stroke and mortality in tuberculous meningitis (TBM). MethodsPatients with TBM diagnosed on the basis of clinical, MRI and cerebrospinal fluid (CSF) criteria were randomized into aspirin 150mg daily or placebo. All the patients received four drug antitubercular treatment- RHZE (rifampicin, isoniazide, pyrazinamide and ethambutol) with or without corticosteroid. The primary endpoint was MRI proven stroke at 3months and secondary end points were mortality and functional outcome assessed by Barthel Index score at 3months. The adverse drug reactions were also analyzed. Results118 TBM patients were randomized into aspirin and placebo groups. The baseline demographic, clinical (severity of meningitis, MRI and CSF changes) were not significantly different between the two groups. 19 (16.1%) patients lost from follow up. 21 (33.3%) patients developed stroke after randomization which was insignificantly lesser in aspirin (24.2%) compared to the placebo group (43.3%; OR 0.42, 95%CI 0.12-1.39). Aspirin resulted in absolute risk reduction of stroke in 19.1% and significant reduction in mortality compared to placebo (21.7% Vs 43.4%, P=0.02). On binary logistic regression analysis, the age (OR 1.09, CI 1.03-1.14, P=0.001) was the only independent risk factor of stroke and aspirin was significantly related to survival (OR 3.17, 95% CI 1.21-8.31). Aspirin was well tolerated and was not withdrawn in any patient because of side effects. InterpretationAspirin resulted in insignificantly lesser strokes and significantly reduced 3month mortality in patients with TBM.