Non-surviving Patients Research Articles

Clinical profile, treatment, and outcomes of patients with COVID-19 in a tertiary referral hospital in South Sumatera, Indonesia: A retrospective single-center study.

Although there are fewer COVID-19 cases in Indonesia, the pandemic is still ongoing. COVID-19 has a significant death rate in Indonesia, but lack of information on the effect of different clinical and demographic factors on COVID-19-related grimness and mortality in Indonesia. This study examined the clinical profile, treatment, and outcomes of patients with COVID-19 at Lahat Regency Hospital in South Sumatera, Indonesia, to find relevant markers that might be utilized to predict the prognosis of these patients. This was a retrospective single-center study of all medical record files of confirmed patients with COVID-19 admitted to Lahat Hospital from September 2020 to August 2021 (n = 285). Descriptive statistics, Chi-square, Mann-Whitney, Multiple Logistic Regression, and Cox's proportional hazards model were used for data analyses. This study included 65 non-hospitalized and 220 hospitalized patients. Hospitalized patients were divided into dead and alive groups. The median age was lower in the non-hospitalized group without gender discrimination, and most hospitalized patients had comorbidities. Vital signs and clinical features were significantly different in hospitalized patients compared to non-hospitalized. The survival patients in the hospitalized group showed lower white blood cell (WBC), neutrophil percentages, and neutrophil-lymphocyte ratio (NLR) but higher lymphocyte and eosinophil. Non-survival patients had elevated alanine aminotransferase (ALT), blood urea nitrogen (BUN), creatinine, blood glucose, and potassium. The use of Favipiravir and Remdesivir was significant between the alive and dead groups. The mean hospital stay for all patients was 9.49 ± 4.77 days, while the median duration of hospital time was 10.73 ± 4.33 days in the survival group and 5.39 ± 3.78 days in the non-survival group. Multiple logistic regression analysis determined respiration rate, WBC, and BUN as predictors of survival. Age and comorbidities are significant elements impacting the seriousness of COVID-19. Abnormal signs in laboratory markers can be used as early warning and prognostic signs to prevent severity and death. Potential biomarkers at various degrees in patients with COVID-19 may also aid healthcare professionals in providing precision medicine and nursing.

The natural killer cell-associated rs9916629-C allele is a novel genetic risk factor for fatal COVID-19.

The severity of COVID-19 is associated with individual genetic host factors. Among these, genetic polymorphisms affecting natural killer (NK) cell responses, as variations in the HLA-E- (HLA-E*0101/0103), FcγRIIIa- (FcγRIIIa-158-F/V), and NKG2C- (KLRC2wt/del ) receptor, were associated with severe COVID-19. Recently, the rs9916629-C/T genetic polymorphism was identified that indirectly shape the human NK cell repertoire towards highly pro-inflammatory CD56bright NK cells. We investigated whether the rs9916629-C/T variants alone and in comparison to the other risk factors are associated with a fatal course of COVID-19. We included 1042 hospitalized surviving and 159 nonsurviving COVID-19 patients as well as 1000 healthy controls. rs9916629-C/T variants were genotyped by TaqMan assays and were compared between the groups. The patients' age, comorbidities, HLA-E*0101/0103, FcγRIIIa-158-F/V, and KLRC2wt/del variants were also determined. The presence of the rs9916629-C allele was a risk factor for severe and fatal COVID-19 (p < 0.0001), independent of the patients' age or comorbidities. Fatal COVID-19 was more frequent in younger patients (<69.85 years) carrying the FcγRIIIa-158-V/V (p < 0.006) and in older patients expressing the KLRC2del variant (p < 0.003). Thus, patients with the rs9916629-C allele have a significantly increased risk for fatal COVID-19 and identification of the genetic variants may be used as prognostic marker for hospitalized COVID-19 patients.

Clinical Outcomes of Ventricular Septal Rupture Complicating ST-Segment Elevation Myocardial Infarction: A Case Series from Siriraj Hospital and Literature Review

Objective: To access the clinical outcomes of ventricular septal rupture (VSR) complicating acute myocardial infarction (AMI) patients in the Faculty of Medicine Siriraj Hospital, Bangkok, Thailand. Materials and Methods: The authors retrospectively reviewed the medical records of Siriraj Hospital between January 2005 and December 2021 in line with the International Classification of Disease, version 10 (ICD-10) code I23.2, which revealed 18 patients who matched the search. Among these, three patients were excluded from the present study as one patient could not access the admission data and the other two were not truly VSR. Results: In total, 15 VSR patients were included in the analysis, comprising eight males and seven females, with mean age of 67.53±7.95 years old. Of all the patients, 60% had anterior ST-segment elevation myocardial infarction. The mean left ventricular ejection fraction was 53.13±14.98%. Coronary angiography was performed in 14 patients (93.37%). In 50% of the patients, left anterior descending artery was the culprit lesion. Ten patients had multi-vessel diseases. Six patients underwent percutaneous coronary intervention (PCI), with the rate of successful reperfusion at 83.33%. For the six patients who underwent PCI, the procedure was performed before the VSR surgical repair. Ten patients underwent coronary artery bypass graft. For the 12 patients who underwent VSR surgical repair, the in-hospital survival rate was 100%. The overall in-hospital mortality rate was 20%. The non-survival patients did not receive the VSR surgical repair. After the median follow-up of three years, no additional mortality rate was reported. Conclusion: The mortality rate of VSR complicating AMI is high, especially, for patients who are not feasible for VSR repair. However, given the limitation in the number of patients involved in the present analysis, the authors could not identify the risk factors for developing in-hospital adverse outcomes. Keywords: Ventricular septal rupture; Acute myocardial infarction; Mechanical complications of myocardial infarction

The course of COVID-19 in patients with hematological malignancies and risk factors affecting mortality: A cross-sectional study

This study aimed to determine the clinical outcomes and risk factors affecting mortality in patients with COVID-19 following hematological malignancy (HM). Patients diagnosed with HM and hospitalized for COVID-19 were included in this retrospective study. The age, demographic and clinical characteristics, prognosis and treatment of surviving and non-surviving patients were compared. A total of 49 patients were included in this study, 17 (34.6%) of whom died within 28 days of being diagnosed with COVID-19. Older age (p = 0.001), diabetes (p = 0.001), chronic obstructive pulmonary disease (p = 0.002), secondary infection (p < 0.001) and secondary bacterial infection (p = 0.005) were statistically significantly higher in non-survivors. The remission status of HM was higher in surviving patients (p < 0.001). In multivariate regression analysis, age (OR: 1.102, p = 0.035) and secondary infection (OR: 16.677, p = 0.024) were risk factors increasing mortality, the remission status of HM (OR: 0.093, p = 0.047) was a protective factor from mortality. The older age, the remission status of HM and secondary infection due to COVID-19 were determined as prognostic factors predicting mortality in HM patients with following COVID-19.

Blood soluble Fas concentrations and ischemic stroke patient mortality

ABSTRACT Background Fas is a major receptor for cell death by apoptosis. Higher blood concentrations of soluble Fas (sFas) have been reported in patients with ischemic stroke compared to control subjects. The aim of this study was to explore the existence or not of an association between blood sFas concentrations and mortality in patients with ischemic stroke. Methods This study included patients admitted to Intensive Care Units with severe and malignant middle cerebral artery infarction (MCAI), defined as acute infarction, in more than 50% of this territory on computed tomography and less than 9 points on the Glasgow Coma Scale (GCS). Serum sFas levels were determined at the time of diagnosis of MMCAI. Results Non-surviving severe MMCAI patients (n = 27) showed lower platelet count (p = 0.004), higher serum sFas (p < 0.001), and lower GCS (p = 0.001) compared to surviving patients (n = 27). Multiple logistic regression found an association of serum sFas levels and mortality at 30 days (OR = 1.015; 95% CI = 1.002–1.027; p = 0.02) after control for CGS and platelet count. Conclusions The main novelty of our study was the existence of an association between high blood sFas concentrations and mortality in patients with ischemic stroke.

Value of thiol and ischemia modified albumin (IMA) in predicting mortality in serious COVID-19 pneumonia

Background/aimViral infections of the respiratory tract are generally related to many factors such as excessive production of cytokines, inflammation, cellular death, redox imbalance or oxidative stress. The aim of this study was to determine the serum levels of thiol and IMA in patients with severe COVID-19 pneumonia to evaluate oxidative stress. Study designThis was a prospective, sectional cohort study conducted at a pandemics hospital between 01.01.2022 and 01.02.2022. MethodsA total of 153 patients who had been confirmed with severe COVID-19 pneumonia in the emergency unit were prospectively analyzed. The control group was formed by 50 healthy volunteers with similar age and no chronic disease history. Thiol and IMA levels were statistically compared both in the patient and the control groups, and within the patient groups (survived and non-survival). ResultsWhile 96 out of 153 patients had survived, 57 patients had non-survival. There was a statistically significant distinction between the survived and non-survival patients with regard to Thiol and IMA levels (p < 0.001). The thiol levels in the patient group were significantly lower compared to the control group, and the IMA levels were significantly higher (p < 0.001). The sensitivity, specificity and NPV were 70.2%, 86.5% and 83% when thiol cut-off value was ≤345.2 μmol/L (AUC: 0.886, p < 0.001). The sensitivity, specificity and NPV were 70.2%, 85.4% and 82.8% when the IMA cut-off was >302.9 ABSU (AUC: 0.875, p < 0.001). ConclusionsOur results demonstrate that thiol and IMA levels may be used as bioindicators for risk classification and mortality in patients with serious COVID-19 pneumonia.

A RETROSPECTIVE STUDY OF PREDICTORS OF MORTALITY IN PATIENTS WITH COVID-19 ADMITTED AT A TERTIARY CARE HOSPITAL.

Background: COVID-19 is associated with huge morbidity and mortality in India. Identication of factors associated with mortality would make a difference in the management of COVID-19 infection-related illness. To eval Objective: uate the risk factors which can predict the outcome in covid 19 survivors and non survivors including patient characteristics, comorbidities, laboratory abnormalities and modes of oxygenation and ventilation among 200 patients with COVID-19 infection admitted to a tertiary care hospital fullling inclusion and exclusion criteria. All the data collected were coded and entered in Microsoft Excel sheet which was re-checked and analyzed using SPSS statistical software version 25. Results: Out of 200 cases, 126(63%) patients were male while 74(37%) patients were female. The overall case-fatality rate among admitted cases was 24(12%) [In non -survivors males (12.7%) and females (0.8%)]. The Univariate analysis showed that more patients in the deceased group had respiratory rate of &gt;30 cycles/min(p&lt;0.001) spo2 75 +/- 13 (p&lt;0.001), Patient who had pulse rate 96+/-19 (p=0.003) found to be signicantly associated. The Mean ± SD of white blood cell count, NLR, SGOT, APTT, S.Bilirubin , Total protein ,Albumin, Creatinine ,RBS, Trop I. CRP, D dimer, LDH ,Ferritin, IL6 ,PCT were statistically signicant and affecting mortality. In non-survived patients needed higher mode of oxygenation .out of 13 patients who required NIV on admission ,15 patients survived and 8 patient non-survived(P=0.002). out of 13 patients who required invasive ventilation, 5 patients survived and 8 patients non survived (p=0.001). Those who received more days of oxygenation they are not survived (6.25±4.19 P=0.001) and those who had prolonged ventilatory days also not survived (4.46±3.50 P=&lt;0.001). Those who had admitted in ICU for mean days of 5±3.60 (p= &lt;0.001) also not survived. All above differences were found to be statistically signicant. There was no signicant difference in the age, gender, clinical features, preexisting comorbidities between the two groups (p&gt;0.05). Multivariate analysis using binary logistic regression was done to nd out independent factors associated with mortality. Logistic regression performed for signicant variables found in the univariate analysis showed higher HRCT CT severity score associated higher odds of death. Conclusion: The higher HRCT CT severity score associated higher odds of death. Lab markers such as raised TLC, NLR, CRP, LDH, ferritin, Ddimer, SGOT, APTT, Sodium, Creatinine, IL6, PCT and low albumin were associated with worse outcomes in COVID-19 illness.

Clinical Utility of Circulating Pentraxin 3 as a Prognostic Biomarker in Coronavirus Disease 2019: A Systematic Review and Meta-analysis.

Pentraxin 3 (PTX3) is involved in inflammation regulation and has a certain association with infectious diseases. However, its specific correlation with infectious diseases remains controversial. This study aimed to analyze the association between them and explore the possible role of PTX3 in the prognosis of coronavirus disease 2019 (COVID-19). Five databases (PubMed, Cochrane Library, Embase, Clinicaltrials.gov, and gray literature) were searched. Outcomes were expressed as a standardized mean difference (SMD) and 95% confidence intervals (CI). The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of included articles. Stata 12 and Meta-DiSc were applied to analyze the pooled data. Receiver operating characteristic (ROC) curves were conducted to determine the prognostic value of PTX3 for mortality. Six articles met the inclusion criteria. Circulating PTX3 levels had a nonsignificant difference between intensive care unit (ICU) and non-ICU patients with COVID-19 [SMD 1.37 (-0.08, 2.81); I2 = 93.9%, P < 0.01], while the PTX3 levels in nonsurvival COVID-19 patients was significantly lower than those in survival patients [SMD -1.41 (-1.92, -0.91); I2 = 66.4%,P=0.051]. Circulating PTX3 had good mortality prediction ability (area under ROC curve, AUC = 0.829) in COVID-19. Funnel plots and Egger's tests showed low probabilities of publication bias. Through sensitivity analysis, the results of this study were robust. This study found that PTX3 was differentially expressed between survival and nonsurvival patients with COVID-19, while there was no significant difference between ICU and non-ICU patients. Meanwhile, circulating PTX3 may be a good biomarker for monitoring the prognosis of COVID-19, which may provide new ideas and directions for clinical and scientific research.

Dysfunctional phenotype of systemic and pulmonary regulatory T cells associate with lethal COVID-19 cases.

Severe cases of COVID-19 present hyperinflammatory condition that can be fatal. Little is known about the role of regulatory responses in SARS-CoV-2 infection. In this study, we evaluated the phenotype of regulatory T cells in the blood (peripheral blood mononuclear cell) and the lungs (broncho-alveolar) of adult patients with severe COVID-19 under invasive mechanical ventilation. Our results show important dynamic variation on Treg cells phenotype during COVID-19 with changes in number and functional parameters from the day of intubation (Day 1 of intensive care unit admission) to Day 7. We observed that compared with surviving patients, non-survivors presented lower numbers of Treg cells in the blood. In addition, lung Tregs of non-survivors also displayed higher PD1 and lower FOXP3 expressions suggesting dysfunctional phenotype. Further signs of Treg dysregulation were observed in non-survivors such as limited production of IL-10 in the lungs and higher production of IL-17A in the blood and in the lungs, which were associated with increased PD1 expression. These findings were also associated with lower pulmonary levels of Treg-stimulating factors like TNF and IL-2. Tregs in the blood and lungs are profoundly dysfunctional in non-surviving COVID-19 patients.

Role of CD8+ T cell exhaustion in the progression and prognosis of acute respiratory distress syndrome induced by sepsis: a prospective observational study

BackgroundCD8+ T cells are important for protective immunity against intracellular pathogens. Excessive amounts of antigen and/or inflammatory signals often lead to the gradual deterioration of CD8+ T cell function, a state called “exhaustion”. However, the association between CD8+ T cell exhaustion and acute respiratory distress syndrome (ARDS) has not been studied. This study was conducted to elucidate how CD8+ T cells and inhibitory receptors were related to the clinical prognosis of ARDS.MethodsA prospective observational study in an emergency department enrolled patients who were diagnosed with sepsis-associated ARDS according to the sepsis-3 criteria and Berlin definition. Peripheral blood samples were collected within 24 h post recruitment. CD8+ T cell count, proliferation ratio, cytokine secretion, and the expression of coinhibitory receptors were assayed.ResultsSixty-two patients with ARDS met the inclusion criteria. CD8+ T cell counts and proliferation rates were dramatically decreased in non-surviving ARDS patients. Increasing programmed cell death 1 (PD-1) expression on the CD8+ T cell surface was seen in patients with worse organ function, while an increasing level of T cell immunoglobulin mucin-3 (Tim-3) was associated with a longer duration of the shock. Kaplan–Meier analysis showed that low CD8+ T cell percentages and increased inhibitory molecule expression were significantly associated with a worse survival rate.ConclusionsCD8+ T cells and coinhibitory receptors are promising independent prognostic markers of sepsis-induced ARDS, and increased CD8+ T cell exhaustion is significantly correlated with poor prognosis.

Extracellular Vesicle-Based Liquid Biopsy Shows Clinical Relevance and Reveals Links with Single-Cell Metabolic Signature in Acute Myeloid Leukemia

Background. Acute myeloid leukemia (AML) is an aggressive disease that shows dysregulated cell metabolism and a high relapse rate. To date, less invasive tools are urgently needed to explore disease dynamics in AML. In this regard, Extracellular Vesicles (EV) from plasma represent a promising tool for liquid biopsy. Also, the material extracted from blood (including circulating leukemic stem cells, LSC) can be used for clinical purposes revealing clinically relevant (metabolic) vulnerabilities. Along with EV profiling in AML patients, we explored the clinically relevant (metabolic) signature carried by CD34+ cells in circulation. Methods. Peripheral blood (PB) was collected from AML patients at diagnosis (n=70) and healthy donors (HD, n=20). EVs were purified from platelet-poor plasma by size exclusion chromatography and ultrafiltration. Quantitative lipidomic profiling was performed by Liquid Chromatography coupled with High-Resolution Mass Spectrometry (LC/HRMS). Single Cell ENergetic metabolism by Profiling Translation inhibition (SCENITH) has been performed in fresh whole blood. Results. We profiled the surface protein of isolated circulating EVs by AML patients at diagnosis. Compared to EV from HD, leukemic EV from newly diagnosed AML patients were mainly enriched in cancer stem cell marker, CD44. Intriguingly, the area under the curve (AUC) confirmed a reliable performance for employing this marker on EVs to discriminate EVs from AML patients. Among other 36 markers explored, CD4 (immune marker), CD105 (mesenchymal stromal cell marker), CD14 (monocyte marker), and CD133-1 (stem cell marker) were highly expressed only in leukemic EVs. In particular, CD11c as the well-known dendritic marker was solely expressed in EVs from some AML patients and totally absent in healthy EVs. By contrast, in circulating leukemic EVs, we observed depletion in markers such as CD62P, CD41b, and CD41a suggesting an impaired function in leukemic megakaryocytes and platelets. From the clinic point of view, according to European LeukemiaNet (ELN) 2017 risk classification, we observed that CD9, CD29, CD31, and CD42a were enriched in the favorable AML group in comparison with adverse/intermediate-risk AML patients. Notably, non-survivor AML patients showed a significant reduction in the expression of EV markers including CD11c, CD69, and ROR-1. Then, to further highlight crucial characteristics in EV composition, we performed an untargeted lipidomic analysis on circulating EVs. Fatty acids (FA) and Diacylglycerols (DG) were significantly overexpressed in leukemic EVs compared to healthy EVs. Leukemic EVs were depleted in Cholesteryl ester (CE) suggesting an increase in membrane stiffness. Interestingly, the lipid CE18:2 was found high in adverse-risk AML patients encouraging further studies on EV lipidomic profiles for better AML stratification. An in-depth investigation of the metabolic dependencies of leukemia (stem) cells from blood might be crucial for detecting novel metabolic vulnerabilities in AML patients. Thus, we applied the innovative SCENITH approach in fresh blood from AML patients at diagnosis. We found that circulating AML CD34+ cells were highly dependent on glucose oxidation and less prone to use fatty acids and amino acids as sources for ATP production when glucose oxidation was inhibited. Also, AML CD34+ cells in circulation reported a higher glycolytic capacity compared to mitochondrial dependence. Towards a clinically relevant implication, SCENITH analysis showed that mitochondrial dependence was solely increased in adverse and intermediate-risk AML patients compared to favorable AML patients. Interestingly, the percentage of mitochondrial dependence in AML CD34+ was positively correlated to the expression of CD24 (cancer stem marker) observed on leukemic EVs suggesting a novel potential link between EV profiling and energy metabolism for leukemia. Conclusion. Overall, these results demonstrate that an abnormal signature characterizes the phenotype of circulating EVs in AML patients. Indeed, the depletion of selected EV markers could be associated with high-risk AML disease and supports their prognostic relevance. This work might reveal novel metabolic vulnerabilities in the AML scenario by exploiting both EV-based liquid biopsy and single-cell metabolic phenotyping.

The predictive value of prognostic nutritional index in patients with COVID-19

Introduction and Aim: It is crucial to identify and start treating the COVID-19 patients who are most at risk of becoming seriously ill as soon as possible. There is some evidence that prognostic nutritional index (PNI) could predict the outcome of some diseases. The study objective was to determine whether PNI is a useful prognostic tool for predicting the outcome of COVID-19-positive patients. Patients and Methods: At Al-Shifaa Hospital in Baghdad Medical City, a total of 160 patients with COVID-19 participated in a study that was designed as a cross-sectional. At the time of admission, information was collected on the patient's history, including clinical, laboratory, and demographic details. The PNI score was determined by 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (/mm3). Patients were followed up for survival. Results: The mortality rate was 14.37%. Survived patients had a mean age of 55.85±16.03 years compared with 64.30 ±14.76 years for died patients with a significant difference. Diabetes was more common among died (39.13%) than survived patients (15.33%) with a significant difference. The median serum level of C-reactive protein (CRP), D-dimer and ferritin in deceased patients was 84 mg/L, 2208 ng/ml and 650 ng/ml, respectively compared with 48 mg/L, 858 ng/ml and 550 ng/ml in survived patients with highly significant differences. The mean PNI in survived and non-survived patients was 40.89±5.9 and 37.86±4.36, respectively with a significant difference. The area under the curve (AUC) for PNI was 0.888, 95%CI = 0.827 and 0.939, p = 0.002 At an ideal cutoff value of 39.08, the test's sensitivity and specificity are 80 % and 74 %, respectively. Conclusion: The PNI score is an easy-to-use, speedy, and cost-effective tool that has the potential to be utilized on a routine basis to predict mortality in patients with COVID-19.

The Role of Hepcidin Level as a Predictor for Mortality in Cancer Patients with Sepsis

BACKGROUND: Sepsis is the most common cause of death in hospitalized cancer patients. Iron metabolism is one system that is strongly influenced by severe infectious and inflammatory conditions. AIM: This study aims to determine the difference in survival based on hepcidin levels in surviving and non-surviving cancer patients with sepsis. METHODS: This study is a cohort study in solid and hematological cancer patients with sepsis aged 18 years and older who were hospitalized from February to June 2022. The criteria for sepsis are the presence of infection accompanied by a Sequential Organ Failure Assessment (SOFA) score of two points or more. A total of 40 samples were included in this study. RESULTS: We found different survival curves in subjects with high hepcidin levels compared to subjects with low hepcidin levels. The hazard ratio (HR) of hepcidin levels was 7.28 (95% confidence interval (CI) 2.35–22.55), p&lt;0.001. In multivariate analysis, hepcidin levels had an adjusted HR of 7.91 (2.51–24.91), p &lt; 0.001. CONCLUSIONS: From the results of this study, it can be concluded that cancer patients with sepsis who have high hepcidin levels have lower survival than patients with low hepcidin levels at 28-day follow-up.

Prognostic Nutritional Index, Controlling Nutritional Status (CONUT) Score, and Inflammatory Biomarkers as Predictors of Deep Vein Thrombosis, Acute Pulmonary Embolism, and Mortality in COVID-19 Patients.

Numerous tools, including nutritional and inflammatory markers, have been evaluated as the predictors of poor outcomes in COVID-19 patients. This study aims to verify the predictive role of the prognostic nutritional index (PNI), CONUT Score, and inflammatory markers (monocyte to lymphocyte ratio (MLR), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), systemic inflammatory index (SII), Systemic Inflammation Response Index (SIRI), and Aggregate Index of Systemic Inflammation (AISI)) in cases of deep vein thrombosis (DVT) and acute pulmonary embolism (APE) risk, as well as mortality, in COVID-19 patients. The present study was designed as an observational, analytical, retrospective cohort study, and included 899 patients over the age of 18 who had a COVID-19 infection, confirmed through real time-polymerase chain reaction (RT-PCR), and were admitted to the County Emergency Clinical Hospital and Modular Intensive Care Unit of UMFST "George Emil Palade" of Targu Mures, Romania between January 2020 and March 20212. Non-Surviving patients were associated with a higher incidence of chronic kidney disease (p = 0.01), cardiovascular disease (atrial fibrillation (AF) p = 0.01; myocardial infarction (MI) p = 0.02; peripheral arterial disease (PAD) p = 0.0003), malignancy (p = 0.0001), tobacco (p = 0.0001), obesity (p = 0.01), dyslipidemia (p = 0.004), and malnutrition (p &lt; 0.0001). Multivariate analysis showed that both nutritional and inflammatory markers had a high baseline value and were all independent predictors of adverse outcomes for all enrolled patients (for all p &lt; 0.0001). The presence of PAD, malignancy, and tobacco, were also independent predictors of all outcomes. According to our findings, higher MLR, NLR, PLR, SII, SIRI, AISI, CONUT Score, and lower PNI values at admission strongly predict DVT risk, APE risk, and mortality in COVID-19 patients. Moreover, PAD, malignancy, and tobacco, all predicted all outcomes, while CKD predicts APE risk and mortality, but not the DVT risk.

Comparison of short-term results of subxiphoid and conventional video-assisted thoracoscopic surgery in diagnostic wedge resections.

This study aimed to compare early results in patients who underwent subxiphoid wedge resection with those operated on using a multiportal approach. We retrospectively evaluated 151 patients who underwent diagnostic wedge resection for suspected interstitial lung disease. Patients who underwent wedge resection via subxiphoid video-assisted thoracoscopic surgery and conventional video-assisted thoracoscopic surgery were compared. The study included 90 men (59.6%) and 61 women (40.4%) with a mean age of 54.8 ± 12 years. Of these, 127 patients underwent conventional video-assisted thoracoscopic surgery and 24 patients underwent subxiphoid video-assisted thoracoscopic surgery. Postoperative complications occurred in 13 patients (8.6%), with no significant difference according to surgical technique. Sex was a significant factor in the rate of complications (12.2% in men vs. 3.2% in women). There was no intraoperative mortality; the 30-day mortality rate was 4% (n = 6). Five nonsurviving patients were in the conventional video-assisted thoracoscopic surgery group and 1 was in the subxiphoid video-assisted thoracoscopic surgery group (p = 0.95). The results of this study indicate that the subxiphoid approach reduced procedure time and length of hospital stay in the early period, while there was no significant difference between the techniques in terms of complications or mortality. Based on these findings, we conclude that surgical outcomes were as successful with the subxiphoid approach as with conventional video-assisted thoracoscopic surgery.

Abstract 13519: 4D Cardiac Magnetic Resonance Strain Associates With Mortality in Duchenne Muscular Dystrophy Associated Cardiomyopathy

Introduction: Cardiomyopathy (CM) is the leading cause of death in Duchenne muscular dystrophy (DMD) but the pace of CM progression is variable. Identification of biomarkers that associate with mortality could allow clinicians to intensify cardiac therapy. Our objective was to determine whether novel 4D (3D+time) cardiac magnetic resonance (CMR) strain analysis predicts mortality. We hypothesized that the magnitude of regional surface strain (E a ) would be significantly decreased in DMD patients that progressed to mortality within 5 years of analysis. Methods: Short axis cine CMR images for DMD survival (n=40) and non-survival (n=9) groups were compiled into 4D sequences. For all 4D sequences, epi- and endocardial borders were segmented across one cardiac cycle for kinematic analysis using a custom-built MATLAB graphical user interface (MathWorks, Natick, MA). Regional E a was measured by determining the relative change in the localized 4D endocardial surface mesh compared to end diastole. Unpaired t-test was used to determine statistical significance. Results: DMD survival patients were younger (13 years [8-24]; median [range]) than non-survival patients (16[12-19]) and a smaller portion had LVEF&lt;55% (11 (28% of total) vs. 6 (67% of total). 63% (n=26) of the survival group had late gadolinium enhancement vs. 100% (n=9) in the non-survival group. Median time to mortality for the non-survival group was 27 months [8-58]. Peak E a was significantly worse in the non-survival group globally and in the basal, mid, and apical regions ( p &lt;0.001 for all; Fig1C). Qualitative E a maps show dramatic differences between groups (Fig1A,B). Conclusion: Regional E a from 4D CMR in DMD was reduced in patients that progressed to mortality within 5 years compared to those that survived. Figure 1: Example colorized surface strain (E a ) from A) survival and B) non-survival patients in both polar map (left) and 3D representations (right). C) Regional E a differences between groups. * p &lt;0.001.

A Prognostic Model for In-Hospital Mortality in Critically Ill Patients with Pneumonia.

To determine the utility of a novel serum biomarker for the outcome prediction of critically ill patients with pneumonia. A retrospective analysis of critically ill patients was performed at an emergency department. The expression and prediction value of parameters were assessed. Binary logistic regression analysis was utilized to determine the indicators associated with in-hospital mortality of pneumonia patients. The Last Absolute Shrinkage and Selection Operator was used to further determine the independent predictors, which were validated by multiple logistic regression. The receiver operator characteristic curve was performed to assess their prediction values. A prognostic nomogram model was finally established for the outcome prediction for critically ill patients with pneumonia. Retinol-binding protein (RBP) was significantly reduced in non-survived and pneumonia patients. CURB-65 score, levels of RBP, and blood urea nitrogen (BUN) were associated with in-hospital mortality of critically ill patients with pneumonia. Their combination was determined to be an ideal prognostic predictor (area under the curve of 0.762) and further developed into a nomogram prediction model (c-index 0.764). RBP is a novel in-hospital mortality predictor, which well supplements the CURB-65 score for critical pneumonia patients.

Characteristics and outcomes in extracorporeal membrane oxygenation support in COVID-19 patients: A nationwide cohort-study in Argentina

IntroductionOne of the great challenges during the COVID-19 pandemic was the management of ventilatory support. Extracorporeal membrane oxygenation (ECMO) was the main strategy for the management of refractory acute respiratory distress syndrome. ObjectiveRetrospective, multicentre cohort study of adult patients who required extracorporeal membrane oxygenation (ECMO) in participating centers. Clinical and paraclinical characteristics were recorded. A comparison was made between surviving and non-surviving patients. In addition, time from symptom onset to ECMO placement, time from mechanical ventilation, and cannulation were analyzed. Material and methodsRetrospective, multicentre cohort study of adult patients who required extracorporeal membrane oxygenation (ECMO) in participating centers. Clinical and paraclinical characteristics were recorded. A comparison was made between surviving and non-surviving patients. In addition, time from symptom onset to ECMO placement, time from mechanical ventilation, and cannulation were analyzed. ResultsTwenty-six patients were included in the analysis. Mortality during ECMO was 42.3% (n=11) and overall hospital mortality was 65.3% (n=17). The patient cohort did not differ in terms of sociodemographic characteristics and predictors of mortality at ICU admission between survivors and non-survivors. Mobile ECMO was performed in 10 patients, while 16 were cannulated in situ at the participating centers. The median time from symptom onset to ECMO was 14.5 days (IQR 10.7–21.5), 11 days (IQR 9.5–15.5) in the survivor group, and 17 days (IQR 12.5–27) in non-survivors. The median IMV time was 28.5 (IQR 13–38.25) days. Driving pressure (12 vs 10cmH2O; p<.01), compliance (37.2 vs 21.4ml/cmH2O; p<.01), and mechanical power (17.4 vs 11.3J/min; p=.051) of the respiratory system showed statistically significant differences when comparing survivors and non-survivors, during the 3rd day of ECMO support. ConclusionIn our cohort, mortality after ECMO and after 30 days of hospital stay, was 42.3%, similar to that stated on the extracorporeal life support organization (ELSO) COVID-19 registry dashboard. Information about patients with COVID-19 who required ECMO during the first wave in Argentina was provided in this analysis.

Impact of COVID-19 on Outcomes of Patients with Hematologic Malignancies: A Multicenter, Retrospective Study.

Patients with hematological malignancies have a high risk of mortality from coronavirus disease 2019 (COVID-19). This study aimed to investigate the impact of COVID-19 on mortality rates in patients with various hematological malignancies and to determine risk factors associated with all-cause mortality. A multicenter, observational retrospective analysis of patients with hematological malignancies infected with COVID-19 between July 2020 and December 2021 was performed. Demographic data, clinical characteristics, and laboratory parameters were recorded. Patients were grouped as non-survivors and survivors. All-cause mortality was the primary outcome of the study. There were 569 patients with a median age of 59 years. Non-Hodgkin lymphoma (22.0%) and multiple myelomas (18.1%) were the two most frequent hematological malignancies. The all-cause mortality rate was 29.3%. The highest mortality rates were seen in patients with acute myeloid leukemia (44.3%), acute lymphoid leukemia (40.5%), and non-Hodgkin lymphoma (36.8%). The non-survivors were significantly older (p<0.001) and had more comorbidities (p<0.05). In addition, there were significantly more patients with low lymphocyte percentage (p<0.001), thrombocytopenia (p<0.001), and high CRP (p<0.001) in the non-survived patients. Age ≥ 65years (p=0.017), cardiac comorbidities (p=0.041), and continuation of ongoing active therapy for hematological cancer (p<0.001) were the independent risk factors for the prediction of mortality. In patients with hematological malignancies, coexistent COVID-19 leads to a higher mortality rate in elderly patients with more comorbidities. Acute myeloid and lymphoid leukemia and non-Hodgkin lymphoma have the highest mortality rates. Older age, cardiac diseases, and continuation of ongoing active therapy for hematological cancer are the independent risk factors for mortality in hematological malignancy patients with COVID-19.

Evaluation of the effects of kidney function tests on prognosis and mortality in geriatric patients with a pulmonary embolism

&lt;b&gt;Aim:&lt;/b&gt; The instant study’s aim is to investigate the effect that BUN and creatinine values have on a prognosis in geriatric patients that are diagnosed with pulmonary embolism. &lt;b&gt;Material and methods:&lt;/b&gt; Our study was planned as a retrospective data review and included patients over the age of 65 with a diagnosis of pulmonary embolism who were admitted applied to Ümraniye Training and Research Hospital between March 1, 2020, and March 1, 2022. Statistical analysis was performed using SPSS version 26.0.&lt;br /&gt; &lt;b&gt;Results:&lt;/b&gt; The study included 148 patients, and 66.89% of them were women. The mortality rate was 28.38%. Considering the blood gas parameters, there was a statistically significant relationship between PH and low saturation and mortality (p=0.029, p=0.001, respectively). Although creatinine values were higher in non-surviving patients than in surviving patients, it was not statistically significant (p=0.252). Blood urea nitrogen was statistically significantly higher in patients who died (p=0.001). Sodium and potassium values were also not associated with mortality (p=0.991, p=0.886, respectively).&lt;br /&gt; &lt;b&gt;Conclusion:&lt;/b&gt; The effect of kidney function tests on the prognosis is very important in managing pulmonary embolism. BUN will be more beneficial to the clinician than creatinine and plasma electrolytes in the management of patients with pulmonary embolism.