Incidence Of Mortality In Patients Research Articles

PTH may predict early mortality in incident patients on hemodialysis: results from a large cohort.

Parathyroid hormone (PTH) is merit as a risk factor for mortality in patients with chronic kidney disease in prevalent hemodialysis patients in a U shape. Most studies, however, do not focus on incident patients and those who died within the first 90days of therapy. We evaluated PTH as a risk factor for mortality in a large cohort population in Brazil. This is an observational cohort study that included 4317 adult patients who initiated hemodialysis between July 1st, 2012 and June 30, 2017. The main outcome was all-cause mortality. Fine-gray sub-distribution hazard models were used to evaluate survival in the presence of a competing event (kidney transplant). Median PTH levels of 252 (118, 479) pg/mL. There were 331 deaths during the first 90days of therapy (6.7%), 430 in a 1-year follow-up (10.7%) and 1282 (32%) during the 5-year study period. Deaths according to PTH < 150, 150-600 and > 600pg/mL corresponded to 38.1%, 33.0% and 28.5%, respectively (p < 0.001). In an adjusted model, patients who started dialysis with PTH < 150pg/mL had a higher mortality risk within the first 90days, but not in 1year and 5years after starting dialysis. Analyses in a subset of patients with a repeated PTH in 1year (N = 1954) showed that although persistent PTH low levels (< 150pg/mL) at 1year were significantly associated with all-cause mortality, this result was not sustained after multiple adjustments. PTH < 150pg/mL confers a high mortality risk in the first 90days of dialysis. If this result reflects poor nutritional conditions, it deserves further investigations.

Geriatric Nutritional Risk Index and First-Year Mortality in Incident Hemodialysis Patients.

The Geriatric Nutritional Risk Index is a simple nutritional screening method, and this study aimed to investigate the association between the initial Geriatric Nutritional Risk Index and all-cause mortality in incident patients in the first year after the initiation of hemodialysis. This study is a retrospective cohort study and used the Korean Renal Data System database. Patients who were eligible for Geriatric Nutritional Risk Index assessment and underwent hemodialysis from January 2016 to December 2019 were included. The primary outcome was all-cause mortality, and outcome evaluation was performed in December 2020. A Cox proportional hazard model was used to analyze the association between the Geriatric Nutritional Risk Index and mortality. A total of 10,545 patients were included, and the mean age was 63.9 ± 3.7 years. The patients were divided into four groups by the quartile of the Geriatric Nutritional Risk Index with a mean value of 96.2 ± 8.2. During the study period, 545 (5.2%) deaths occurred. The surviving patients had higher Geriatric Nutritional Risk Index values than ones who died in the first year of hemodialysis initiation (96.6 ± 7.5 vs. 88.2 ± 9.3, p < 0.001). Quartile 1 (Geriatric Nutritional Risk Index < 91.8) showed a significantly increased risk of all-cause (Hazard Ratio: 2.56; 95% Confidence Interval: 2.13-3.09; p < 0.001) and cardiovascular mortality (Hazard Ratio: 22.29; 95% Confidence Interval: 1.71- 3.08; p < 0.001) at the first year in comparison with Quartile 4 (Geriatric Nutritional Risk Index ≥ 101.3). In areas under the receiver-operating characteristic curves of all-cause mortality, the Geriatric Nutritional Risk Index model improved predictive values, compared to the baseline model. The area with the Geriatric Nutritional Risk Index model was significantly higher than the one with a model including albumin or body mass index (p < 0.001). These findings suggest that a low Geriatric Nutritional Risk Index (<91.8) is associated with first-year all-cause and cardiovascular mortality in patients who start hemodialysis and may be a useful and reproducible tool for assessing prognoses in this population.

Incidence of major cardiovascular events at 1, 2, and 5years and mortality in incident patients on peritoneal dialysis regarding their nutritional status by bioimpedanciometry: A multicenter study in Colombia.

The nutritional status of incident patients on peritoneal dialysis (PD) has been associated with survival outcomes. Bioimpedanciometry (BCM) enables to establish a nutritional diagnosis, the volume status, and correlates these findings with survival. This study used a retrospective multicenter historical cohort. In this study, which included 420 incident patients on peritoneal dialysis with a 5-year follow-up, a cumulative incidence of major adverse cardiovascular events (MACE) of 28.8% was found, being higher in the diabetic population at 36.8%. In regard to the nutritional status in this population, it was found that approximately 44% had altered nutritional status; 34% were found to be in sarcopenia; 6.7% sarcopenic obesity; and 2.8% in obesity (p< 0.001). In the survival analysis, a lower probability of survival was found in patients with overhydration (OH) greater than 3L (p< 0.001) and in patients with altered nutritional status due to sarcopenia, sarcopenic obesity, and obesity (p 0.016). According to survival in the subgroup of the diabetic population, a lower probability of survival was found in this group of patients (p: 0.011). The overall mortality of the study population was 18%, being higher in the first 2years, with the most important causes of mortality being cardiovascular. Of the deceased population, 51% were diabetic patients (p: 0.012). In incident patients on peritoneal dialysis, sarcopenic obesity, sarcopenia, overhydration status determined by BCM, and having a diagnosis of diabetes are related to a lower probability of survival; MACE outcomes are more frequent in the diabetic population.

Serum chloride as a marker of cardiovascular and all-cause mortality in chronic hemodialysis patients: 5-Year follow-up study

BackgroundHypochloremia has been associated with increased mortality in patients with hypertension, heart failure, sepsis, and chronic kidney disease (CKD). The pathophysiological mechanisms of this finding are not clear. There are no studies describing an association between serum chloride levels (Cl−) and mortality in incident chronic hemodialysis (HD) patients. MethodRetrospective cohort study of the incident population in our chronic outpatient hemodialysis program between January 1, 2016, and January 1, 2021 (N=374). Survival time was collected in all patients and analyzed using the Kaplan–Meyer method. A multivariate Cox regression model was performed to predict the probability of survival, applying a stepwise procedure. ResultsDuring the median follow-up period of 20 months, 83 patients died. The 5-year overall survival rate for our patients was 45%. Both natremia and chloremia had no significant differences when compared by sex, vascular access, or etiology. There was an inverse correlation between Cl− and interdialytic weight gain (r=−0.15) (p=0.0038). Patients belonging to the quartile with lower Cl− levels had less probability of survival than patients in the quartile with higher Cl− levels (27% and 68%, respectively, p=0.019). On the other hand, in the multivariate Cox regression model, variables significantly associated with higher mortality were being older, having higher baseline comorbidity by modified Charlson index, not taking diuretics and having lower albumin and chloride levels. Particularly, higher Cl− levels was independently associated with both lower all-cause mortality (adjusted hazard ratio [HR]=0.84; 95% confidence interval [CI], 0.77–0.92; p=0.0001) and cardiovascular mortality (HR 0.9; 95% CI, 0.83–0.97; p<0.0057). ConclusionsLower Cl− levels were associated with higher all-cause and cardiovascular mortality in incident patients on chronic hemodialysis in our health area.

Factors Affecting the Mortality of Patients Undergoing Open Heart Surgery with Cardiopulmonary Bypass at Dr. M. Djamil General Hospital, Padang, Indonesia

Background: Morbidity and mortality of patients after cardiac surgery can be influenced in the preoperative, intraoperative, and postoperative periods. This study aimed to explore factors that affect the mortality of patients undergoing open heart surgery with cardiopulmonary bypass at Dr. M. Djamil General Hospital, Padang, Indonesia.&#x0D; Methods: This study is an analytical observational research with a cross-sectional approach and uses secondary data obtained from the medical record installation of Dr. M. Djamil General Hospital, Padang, Indonesia. A total of 57 research subjects participated in this study. Univariate, bivariate, and multivariate analyses were carried out using SPSS software.&#x0D; Results: The final multivariate modeling results show that the variables that influence patient mortality are EuroSCORE II (p-value=0.003) and duration of CPB (p-value=0.003). With an odds ratio of 37.21 groups, EuroSCORE II high risk had a risk of death 37.21 times higher than the low-risk group (CI 3.325 – 416.324). Meanwhile, increasing the duration of CPB by one minute increased the risk of mortality 1.02 times (CI 1.006 – 1.030). Meanwhile, there is no influence of variables (NYHA, LV function, ACC duration) on the incidence of mortality in patients undergoing open heart surgery with a machine cardiopulmonary bypass at Dr. M. Djamil General Hospital, Padang.&#x0D; Conclusion: EuroSCORE II affects the mortality of patients undergoing open heart surgery with CPB. The duration of CPB affects the mortality of patients undergoing open heart surgery with CPB.

#3355 GERIATRIC NUTRITIONAL RISK INDEX AND EARLY MORTALITY IN INCIDENT HEMODIALYSIS PATIENTS

Abstract Background and Aims The nutrition status at initiation of hemodialysis (HD) might be associated with early mortality in patients undergoing HD. The Geriatric Nutritional Risk Index (GNRI) is a simple and useful nutritional screening method, and this study aimed to investigate the association between the initial GNRI and mortality in incident patients in the first year after initiation of HD. Method A nationwide retrospective cohort study was conducted based on the Korean Renal Data System database. Patients who underwent HD from January 2016 to December 2019 and were eligible for GNRI screening were included. They were followed up until the end of 2020 or study departure. Patients were compared by GNRI quartiles. The primary outcome was all-cause mortality, and a Cox proportional hazard model was used to analyze the association between GNRI and mortality. Accuracy comparison of the models including GNRI or body mass index (BMI) were analyzed by Receiver-operating characteristic curves, and the differences were tested by the DeLong test. Results A total of 10,545 patients were included, and the mean age was 63.9 ± 3.7 years. Patients with GNRI &amp;lt; 91.4 at the initiation of HD were older, were more often female, and a lower proportion of them had arteriovenous fistula for vascular access. A high GNRI value at the initiation of HD was associated with low all-cause mortality (hazard ratio (HR) 0.93; 95% confidence interval (95%CI) 0.92–0.94; p &amp;lt;0.001). The group with GNRI &amp;lt; 91.4 (Quartile 1) showed the lowest survival in the first year after HD initiation (p &amp;lt; 0.001). Quartile 1 and Quartile 2 (91.4 – 96.8) showed a significantly increased all-cause mortality (HR 3.64; 95%CI 2.60 – 5.10; p &amp;lt; 0.001 for Quartile 1 and HR 1.55; 95% CI 1.09 – 2.22; p = 0.015 for Quartile 2) in comparison with Quartile 4 (101.4 – 129.6). Risk of cardiovascular mortality was high in the Quartile 1 (vs. Quartile 4; HR 3.16; 95%CI 1.94 – 5.13; p &amp;lt; 0.001). In addition, Area Under the ROC Curve (AUC) values for all-cause mortality were 79.1 (95%CI 77.1–81.2) and 75.9 (95%CI 73.8–78.1) for GNRI and BMI, respectively, and the differences of AUCs were significant (p &amp;lt; 0.001). Conclusion This study demonstrates that low GNRI levels are associated with all-cause and cardiovascular mortality in HD patients during the early ESRD period. These findings suggest that GNRI is a significant predictor of mortality in these patients.

Serum chloride as a marker of cardiovascular and all-cause mortality in chronic hemodialysis patients: 5-Year follow-up study

BackgroundHypochloremia has been associated with increased mortality in patients with hypertension, heart failure, sepsis, and chronic kidney disease (CKD). The pathophysiological mechanisms of this finding are not clear. There are no studies describing an association between serum chloride levels (Cl−) and mortality in incident chronic hemodialysis (HD) patients. MethodRetrospective cohort study of the incident population in our chronic outpatient hemodialysis program between January 1, 2016, and January 1, 2021 (N=374). Survival time was collected in all patients and analyzed using the Kaplan–Meyer method. A multivariate Cox regression model was performed to predict the probability of survival, applying a stepwise procedure. ResultsDuring the median follow-up period of 20 months, 83 patients died. The 5-year overall survival rate for our patients was 45%. Both natremia and chloremia had no significant differences when compared by sex, vascular access, or etiology. There was an inverse correlation between Cl− and interdialytic weight gain (r=−0.15) (p=0.0038). Patients belonging to the quartile with lower Cl− levels had less probability of survival than patients in the quartile with higher Cl− levels (27% and 68%, respectively, p=0.019). On the other hand, in the multivariate Cox regression model, variables significantly associated with higher mortality were being older, having higher baseline comorbidity by modified Charlson index, not taking diuretics and having lower albumin and chloride levels. Particularly, higher Cl− levels was independently associated with both lower all-cause mortality (adjusted hazard ratio [HR]=0.84; 95% confidence interval [CI], 0.77–0.92; p=0.0001) and cardiovascular mortality (HR 0.9; 95% CI, 0.83–0.97; p<0.0057). ConclusionsLower Cl− levels were associated with higher all-cause and cardiovascular mortality in incident patients on chronic hemodialysis in our health area.

RELATIONSHIP OF COMMORBID DISEASE TO MORTALITY EVENTS IN COVID-19 PATIENTS

Background: Covid-19 is a disease caused by acute respiratory syndrome due to corona virus 2. Patients with Covid-19 experience symptoms of severe shortness of breath resulting in death. The risk of death for Covid-19 sufferers will be greater if the patient has a history of comorbid diseases such as hypertension, diabetes mellitus, cardiovascular disease or kidney disease.Objective: The purpose of this study was to determine the relationship between comorbid diseases and the incidence of mortality in patients with Covid-19.Method: Research design using descriptive analytic. The research population was all Covid-19 sufferers who were treated at Mojowarno Christian Hospital (RSK) during 2021 totaling 450 sufferers. The research sample was 212 respondents with a sampling technique using systematic random sampling. The data was obtained from the medical records of Covid-19 patients who were treated at the Mojowarno Hospital. Statistical test using chi square and odds ratio with a significance level of P &lt;0.05. Results: The results of the study found that comorbid diabetes mellitus showed a result of P: 0.000, meaning that there was a relationship between comorbid diabetes mellitus and the incidence of mortality in patients with Covid-19. Comorbid kidney disease shows a P value: 0.003, meaning that there is a relationship between comorbid kidney disease and the occurrence of mortality in Covid-19 sufferers. Comorbid heart disease results obtained P: 0.089, meaning that there is no relationship between comorbid heart disease and mortality in patients with Covid-19. Hypertensive comorbid disease on mortality with a P value: 0.134 meaning that there is no relationship between hypertension comorbid disease and the risk of mortality in patients with Covid-19. Conclusion:Covid-19 sufferers who have comorbid diabetes mellitus cause greater mortality. This is because diabetes mellitus can cause a cytokine storm which plays a role in increasing the severity of COVID-19 sufferers so that it often causes death.

The burden of Clostridioides difficile on COVID-19 hospitalizations in the USA.

Clostridioides difficile infection (CDI) is the leading cause of hospital acquired-infectious diarrhea in the USA. In this study, we assess the prevalence and impact of CDI in COVID-19 hospitalizations in the USA. We used the 2020 National Inpatient Sample database to identify adult patients with COVID-19. The patients were stratified into two groups based on the presence of CDI. The impact of CDI on outcomes such as in-hospital mortality, ICU admission, shock, acute kidney injury (AKI), and sepsis rates. Multivariate regression analysis was performed to assess the effects of CDI on outcomes. The study population comprised 1581585 patients with COVID-19. Among these, 0.65% of people had a CDI. There was a higher incidence of mortality in patients with COVID-19 and CDI compared with patients without COVID-19 (23.25% vs 13.33%, P<0.001). The patients with COVID-19 and CDI had a higher incidence of sepsis (7.69% vs 5%, P<0.001), shock (23.59% vs 8.59%, P<0.001), ICU admission (25.54% vs 12.28%, P<0.001), and AKI (47.71% vs 28.52%, P<0.001). On multivariate analysis, patients with CDI had a statistically significant higher risk of mortality than those without (aOR=1.47, P<0.001). We also noted a statistically significant higher risk of sepsis (aOR=1.47, P<0.001), shock (aOR=2.7, P<0.001), AKI (aOR=1.55, P<0.001), and ICU admission (aOR=2.16, P<0.001) in the study population. Our study revealed the prevalence of CDI in COVID-19 patients was 0.65%. Although the prevalence was low, its presence is associated with worse outcomes and higher resource utilization.

Abstract 13550: Electrocardiographic-Based Artificial Intelligence Model in Prediction of 1-year Mortality in Heart Failure With Reduced Ejection Fraction

Objectives: To assess whether electrocardiography (ECG)-based artificial intelligence (AI) algorithm developed to detect 1-year mortality in patients with HF with reduced ejection fraction (HFrEF). Methods and results: Data from two hospital visits (2016 Oct to 2021 Apr) was used. Participants with good quality baseline ECGs and HFrEF were included. We tested the hypothesis that the application of AI to the ECG could identify 1-yr mortality in HFrEF patients. A total of 16,228 (64% male, mean age of 58.5) were eligible. When tested on an independent set of 16,228 patients, the network model yielded values for the area under the curve, sensitivity, specificity, and accuracy of 0.83, 83.3%, and 64.2%, respectively ( Figure a ). Those with a positive AI screen were at 2.6 times the risk (p&lt;0.0001) of developing future mortality compared with those with a negative screen ( Figure b ). We used a sensitivity map to visualize the ECG region used in the AI model to detect high 1-yr mortality in HFrEF ( Figure c ). The map shows that the AI model focused on the QRS complex, particularly the R-wave, in most patients. Conclusions: The application of AI to the ECG permits the ECG to serve as a powerful screening tool for detecting 1-yr mortality in HFrEF. Figure a. The area under the curve of the convolutional neural network used to identify 1-year mortality of heart failure with reduced ejection fraction. Figure b. Long-term incidence of mortality in patients with initially 1-year mortality stratified by artificial intelligence classification. Figure c. Sensitivity map of a deep learning model for detecting 1-year mortality in heart failure with reduced ejection fraction.

Impact of being underweight on peri-operative and post-operative outcomes of total knee or hip arthroplasty: A meta-analysis.

Many systematic reviews have focused on assessing the effect of body mass index (BMI) on the outcomes and complications associated with total hip arthroplasty (THA) and total knee arthroplasty (TKA), but primarily dealt with obesity compared to normal weight (NW). None of these reviews attempted to assess the effect of low BMI or underweight (UW) compared to NW in patients undergoing THA or TKA. This review aims to compare specific operative outcomes such as operation duration, length of hospital stay, and post-operative complications including mortality, infections, deep vein thrombosis, etc. along with re-hospitalization and reoperation rates between UW and NW patients undergoing THA, TKA or both. An electronic search was performed in PubMed, Scopus, Excerpta Medica database (EMBASE), Web of Science (WoS), and Cochrane Central Register of Controlled Trials (CENTRAL) along with a manual search. The quality of the studies was assessed using the Newcastle-Ottawa scale for cohort studies. The data were subjected to both qualitative and quantitative analysis. Thirteen retrospective and five prospective cohort studies were included. The quality of included studies was assessed to be good to fair. The length of hospital stay after TKA or THA was found to be significantly higher for UW patients when compared to NW patients, with a mean difference: 0.39 95%CI: [0.06, 0.72], P = 0.02 (in days). Studies presenting both THA and TKA together as total joint arthroplasty showed an increased incidence of mortality in patients treated with THA or TKA alone, Odds ratio: 4.18 95%CI: [2.88, 6.07]. A higher incidence of post-operative complications was also observed in UW patients undergoing THA. UW patients undergoing THA or TKA had a higher incidence of post-operative complications and were associated with a higher readmission rate. Moreover, UW patients were associated with an increased incidence of mortality in the studies that reported THA and TKA together.

Association between Mineralocorticoid Receptor Antagonist and Mortality in SARS-CoV-2 Patients: A Systematic Review and Meta-Analysis.

Since the onset of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, various potential targeted therapies for SARS-CoV-2 infection have been proposed. The protective effects of mineralocorticoid receptor antagonists (MRA) against tissue fibrosis, pulmonary and systemic vasoconstriction, and inflammation have been implicated in potentially attenuating the severity of SARS-CoV-2 infection by inhibiting the deleterious effects of aldosterone. Furthermore, spironolactone, a type of MRA, has been suggested to have a beneficial effect on SARS-CoV-2 outcomes through its dual action as an MRA and antiandrogen, resulting in reduced transmembrane protease receptor serine type 2 (TMPRSS2)-related viral entry to host cells. In this study, we sought to investigate the association between MRA antagonist therapy and mortality in SARS-CoV-2 patients via systematic review and meta-analysis. The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE and EMBASE databases were searched for studies that reported the incidence of mortality in patients on MRA with SARS-CoV-2 infection. Pooled odds ratio (OR) and 95% confidence interval (CI) of the outcome were obtained using the random-effects model. Five studies with a total of 1,388,178 subjects (80,903 subjects receiving MRA therapy) met the inclusion criteria. We included studies with all types of MRA therapy including spironolactone and canrenone and found no association between MRA therapy and mortality in SARS-CoV-2 infection (OR = 0.387, 95% CI: 0.134–1.117, p = 0.079).

Treatment Strategies for Ventricular Septal Rupture After Myocardial Infarction: A Single-Center Experience

ObjectiveTo analyze treatment strategies, prognosis, and related risk factors of patients with postinfarction ventricular septal rupture, as well as the impact of timing of surgical intervention.MethodsA total of 23 patients diagnosed with postinfarction ventricular septal rupture who were non-selectively admitted to Shanxi Provincial Cardiovascular Hospital between October 2017 and August 2021 were included in this study. The relevant clinical data, operation-related conditions, and follow-up data were summarized for all patients. The Kaplan-Meier method and log-rank test were used for the cumulative incidence of unadjusted mortality in patients with different treatment methods. Multivariate logistic regression was used to evaluate the independent risk factors for in-hospital patient mortality.ResultsThe mean age of the study patients was 64.43 ± 7.54 years, 12(52.2%) were females. There was a significant difference in terms of postoperative residual shunt between the surgical and interventional closure groups (5.9 vs. 100%, respectively; P < 0.001). The overall in-hospital mortality rate was 21.7%; however, even though the surgical group had a lower mortality rate than the interventional closure group (17.6 vs. 33%, respectively), this difference was not statistically significant (P = 0.576). Univariate analysis showed that in-hospital survival group patients were significantly younger than in-hospital death group patients (62.50 ± 6.53 vs. 71.40 ± 7.37 years, respectively; P = 0.016), and that women had a significantly higher in-hospital mortality rate than men (P = 0.037). The average postoperative follow-up time was 18.11 ± 13.92 months; as of the end of the study all 14 patients in the surgical group were alive, Two out of four patients survived and two patients died after interventional closure. Univariate analysis showed that interventional closure was a risk factor for long-term death (P < 0.05).ConclusionSurgical operation is the most effective treatment for patients with postinfarction ventricular septal rupture; however, the best timing of the operation should be based on the patient's condition and comprehensively determined through real-time evaluation and monitoring. We believe that delaying the operation time as much as possible when the patient's condition permits can reduce postoperative mortality. Interventional closure can be used as a supplementary or bridge treatment for surgical procedures.

Associations of Chinese Herbal Medicine Use with the Risks of Acute Exacerbation and Mortality in Patients with Chronic Obstructive Pulmonary Disease: A Nationwide Retrospective Cohort Study.

Objectives: This study aimed to assess the correlation of exacerbation and the mortality rate in patients with chronic obstructive pulmonary disease (COPD) between biomedical treatments with or without Chinese herbal medicine (CHM) as an adjunct. Design: A total of 81,261 COPD patients were identified from the National Health Insurance Research Database in Taiwan between 2001 and 2012. After screening and matching, 3176 COPD patients were included in the study. Statistical analyses were performed to assess the differences in the baseline characteristics. The authors used the Cox proportional hazard regression analysis to calculate the risks of mortality and hospitalization due to acute exacerbation of COPD within 1 year between a CHM user cohort and non-CHM user cohort. The cumulative incidence of mortality in COPD patients with or without CHM treatment was calculated by the Kaplan-Meier method. Results: COPD patients in the CHM user cohort demonstrated a significantly lower risk of mortality (p < 0.001) and acute exacerbation (p < 0.05), compared with the non-CHM user cohort. In addition, the CHM users exhibited a reduced cumulative incidence of mortality compared with the non-CHM user cohort (p < 0.001). Xiao Qing Long Tang and Fritillariae thunbergii were the most common Chinese herbal formula and single Chinese herb prescribed for COPD patients. Conclusion: Combining CHM with biomedical treatment might reduce the risk of acute exacerbation and incidence of mortality in patients with COPD.

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

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

Investigating the Causes and Incidence of Mortality in Patients Using Biological Disease Modifying Antirheumatic Drug (DMARD) and the Mortality Rates Thereof Compared to the General Population

AIM: Disease-modifying antirheumatic drugs (DMARDs) are used in the treatment of most rheumatological diseases (1). There is a number of studies availabile in the literature, in which the effect of DMARDs on mortality has been investigated; however these studies were generally performed on rheumatoid arthritis (RA), and on tumor necrosis factor inhibitors (TNFi) in particular (2-5). Hence, we aimed to conduct a more comprehensive study investigating the effects of using abatacept, adalimumab, certolizumab pegol, etanercept, golimumab, infliximab, rituximab, secukinumab, tofacitinib and tocilizumab on mortality in patients with RA, ankylosing spondylitis (AS), psoriatic arthritis (PsA), Behçet's disease, systemic lupus erythematosus (SLE), Takayasu's arteritis, systemic sclerosis (SSc), Sjogren's syndrome and other rheumatological diseases.&#x0D; MATERIAL AND METHOD: 847 patients that have used bDMARDs were included in our study. Age, gender, diagnosis and treatment information of these patients were retrospectively scanned and recorded. Death records were obtained from the National Death Notification Service (6), whereas the population records were obtained from the Turkish Statistical Institute (7). bDMARD-related incidence rates (IRs) for mortality was calculated.&#x0D; RESULTS: A total of 847 patients, 464 (54.8%) of whom were female and 383 (45.2%) of whom were male, were included in the study. Mortality occurred in a total of 18 patients (2.1%) during the treatment process. Of these 18 patients, 5 patients were using rituximab, 4 patients were using infliximab, 3 patients were using adalimumab, 3 patients were using etanercept, 2 patients were using tocilizumab, and 1 patient were using golimumab. In terms of the mortalities by the type of diagnosis, 13 mortalities occurred in the group of patients diagnosed with RA, whereas 1 mortality occurred in each of the groups consisting of patients diagnosed with AS, PsA, Takayasu arteritis, granulomatosis with polyangiitis (Wegener) or SSc. The overall mortality incidence of the patients was calculated as 5.28 cases per 1000 years. Compared to the general population, the standardized mortality ratio (SMR) of the patients using bDMARDs was found to be 3.147 ((confidence interval (CI): 1.924-4.877)).&#x0D; CONCLUSIONS: Our study is the first mortality study conducted in Turkey on patients with rheumatologic disease that use bDMARDs. The incidence rate (IR) for mortality we have found in patients using bDMARDs was comparable to the IRs reported in the literature, however we have found a higher standart mortalie ratio (SMR) in our cohort compared to the Turkish population. In this respect, it is necessary to conduct larger-scale controlled studies.

Stewardship Nightmare: Ceftolozane/Tazobactam–Resistant Pseudomonas aeruginosa Infections Accelerated by the COVID-19 Pandemic

Background: The Centers for Disease Control and Prevention reported 32,600 cases, 2,700 deaths, and healthcare costs of 767 million dollars attributed to multidrug-resistant Pseudomonas aeruginosa. A recent study of 128 patients with nosocomial pneumonia due to P. aeruginosa showed the noninferiority of ceftolozane-tazobactam compared to meropenem. However, the resistance of ceftolozane-tazobactam due to AmpC mutations has been described. Compared with 2019, we observed an increase from 2 to 13 cases of ceftolozane-tazobactam–resistant P. aeruginosa (CRPA) during the COVID-19 pandemic at our institution in the Bronx, New York. Methods: A report of patients with CRPA between March and August 2020 was obtained. Data collected included demographics, hospitalization/IV antibiotic use in prior 90 days, SARS-CoV-2 PCR result, ICU admission, length of stay, antibiotic days of therapy, mortality, etc. Results: In total, 13 patients with CRPA infection were reviewed (Table 1). Among them, 2 patients were on the same inpatient medical-surgical unit but separated by 5 months. Also, 11 patients were from different medical-surgical units or ICUs. In addition, 5 patients (38%) were SARS-CoV-2 PCR positive. None of these COVID-19 patients were cohorted on the same unit, making horizontal spread of CRPA or COVID-19 unlikely. Finally, 8 of these patients died while hospitalized (4 were COVID-19 patients). Conclusions: We found a high incidence of mortality in patients with CRPA infection. Many patients had prolonged hospital stay and required ICU admission. Few patients were from long-term care facilities. Given the associated morbidity and mortality, increased surveillance and intensified antimicrobial stewardship efforts are needed to mitigate the impact of CRPA during the COVID-19 pandemic.Funding: NoDisclosures: None

\u03b2-Adrenergic blockade in patients with dementia and hip fracture is associated with decreased postoperative mortality

PurposeDementia, present in 20% of hip fracture patients, is associated with an almost threefold increase in postoperative mortality risk. These patients have a substantially higher incidence of cardiovascular, respiratory, and cerebrovascular mortality after hip fracture surgery compared to patients without dementia. This study aimed to investigate the association between beta-blocker therapy and postoperative mortality in patients with dementia undergoing hip fracture surgery.MethodsThis nationwide study included all patients in Sweden with the diagnosis of dementia who underwent emergency surgery for a hip fracture between January 2008 and December 2017. Cases where the hip fracture was pathological or conservatively managed were not included. Poisson regression analysis with robust standard errors was performed while controlling for confounders to determine the relationship between beta-blocker therapy and all-cause, as well as cause-specific, postoperative mortality.ResultsA total of 26,549 patients met the study inclusion criteria, of whom 8258 (31%) had ongoing beta-blocker therapy at time of admission. After adjusting for clinically relevant variables, the incidence of postoperative mortality in patients receiving beta-blocker therapy was decreased by 50% at 30 days [adj. IRR (95% CI) 0.50 (0.45–0.54), p < 0.001] and 34% at 90 days [adj. IRR (95% CI) 0.66 (0.62–0.70), p < 0.001]. Cause-specific mortality analysis demonstrated a significant reduction in the incidence of postoperative cardiovascular, respiratory, and cerebrovascular death within 30 and 90 days postoperatively.ConclusionBeta-blocker therapy is associated with decreased postoperative mortality in hip fracture patients with dementia up to 90 days after surgery. This finding warrants further investigation.

Prediction of Mortality Incidence in Patients with Chronic Kidney Disease Based on Influential Prognostic Factors with Competing Risks Approach

Background: Chronic Kidney Disease (CKD) is a disease in which the kidney’s functionality declines gradually. The aim of this study was to identify significant laboratory prognostic factors on death due to CKD in a clinical complex. Materials and Methods: A retrospective study including 109 patients with the end-stage renal disease treated at Iran Helal pharmaceutical and the clinical complex was conducted between 2014-2018. The survival time was set as the time interval between starting dialysis until death due to CKD. Also, the transplantation was considered as competing risk, which was occurred for a few patients. A three-parameter Gompertz model was used that considers both the event of interest and the competing event simultaneously. Results: Death due to CKD occurred in 29 (26.6%) of the patients and 19(17.4%) with transplantation. Serum uric acid was a significant prognostic factor that decreased the hazard of mortality by 21%. Serum phosphorus and age by increasing the risk of death, were poor prognoses for the event of interest. Serum uric acid and phosphorus 6.9-9.9 (mg/dl) were associated with 72% and 4.05-fold increased hazard of transplant, respectively. The 4-year cumulative incidence of death and transplant was 48.4% and 29.2%, respectively. Conclusion: We have deduced that high serum phosphorus levels and increased levels of age were associated with worse outcomes. High serum uric acid level was related to better survival, which could be explained by having a better protein-rich diet alongside the high albumin level. [GMJ.2020;9:e1798]

Prediction of Mortality Incidence in Patients with Chronic Kidney Disease Based on Influential Prognostic Factors with Competing Risks Approach.

Background: Chronic Kidney Disease (CKD) is a disease in which the kidney’s functionality declines gradually. The aim of this study was to identify significant laboratory prognostic factors on death due to CKD in a clinical complex. Materials and Methods: A retrospective study including 109 patients with the end-stage renal disease treated at Iran Helal pharmaceutical and the clinical complex was conducted between 2014-2018. The survival time was set as the time interval between starting dialysis until death due to CKD. Also, the transplantation was considered as competing risk, which was occurred for a few patients. A three-parameter Gompertz model was used that considers both the event of interest and the competing event simultaneously. Results: Death due to CKD occurred in 29 (26.6%) of the patients and 19(17.4%) with transplantation. Serum uric acid was a significant prognostic factor that decreased the hazard of mortality by 21%. Serum phosphorus and age by increasing the risk of death, were poor prognoses for the event of interest. Serum uric acid and phosphorus 6.9-9.9 (mg/dl) were associated with 72% and 4.05- fold increased hazard of transplant, respectively. The 4-year cumulative incidence of death and transplant was 48.4% and 29.2%, respectively. Conclusion: We have deduced that high serum phosphorus levels and increased levels of age were associated with worse outcomes. High serum uric acid level was related to better survival, which could be explained by having a better protein-rich diet alongside the high albumin level.