Mortality In Patients Research Articles

Intake of animal and plant proteins and risk of all-cause mortality in patients with type 2 diabetes: results from NHANES

Intake of animal and plant proteins and risk of all-cause mortality in patients with type 2 diabetes: results from NHANES

Effects of acetaminophen use on mortality of patients with acute respiratory distress syndrome: secondary data mining based on the MIMIC-IV database

Effects of acetaminophen use on mortality of patients with acute respiratory distress syndrome: secondary data mining based on the MIMIC-IV database

Machine learning-based prediction of one-year mortality in ischemic stroke patients

Abstract Background Accurate prediction of mortality following an ischemic stroke is essential for tailoring personalized treatment strategies. This study evaluates the effectiveness of machine learning models in predicting one-year mortality after an ischemic stroke. Methods Five machine learning models were trained using data from a national stroke registry, with logistic regression demonstrating the highest performance. The SHapley Additive exPlanations (SHAP) analysis explained the model’s outcomes and defined the influential predictive factors. Results Analyzing 8183 ischemic stroke patients, logistic regression achieved 83% accuracy, 0.89 AUC, and an F1 score of 0.83. Significant predictors included stroke severity, pre-stroke functional status, age, hospital-acquired pneumonia, ischemic stroke subtype, tobacco use, and co-existing diabetes mellitus (DM). Discussion The model highlights the importance of predicting mortality in enhancing personalized stroke care. Apart from pneumonia, all predictors can serve the early prediction of mortality risk which supports the initiation of early preventive measures and in setting realistic expectations of disease outcomes for all stakeholders. The identified tobacco paradox warrants further investigation. Conclusion This study offers a promising tool for early prediction of stroke mortality and for advancing personalized stroke care. It emphasizes the need for prospective studies to validate these findings in diverse clinical settings.

QTc interval prolongation impact on in-hospital mortality in acute coronary syndromes patients using artificial intelligence and machine learning

Abstract Background Prediction of mortality in hospitalized patients is a crucial and important problem. Several severity scoring systems over the past few decades and machine learning models for mortality prediction have been developed to predict in-hospital mortality. Our aim in this study was to apply machine learning (ML) algorithms using QTc interval to predict in-hospital mortality in ACS patients and compare them to the validated conventional risk scores. Results This study was retrospective, using supervised learning, and data mining. Out of a cohort of 500 patients admitted to a tertiary care hospital from September 2018 to August 2020, who presented with ACS. Prediction models for in-hospital mortality in ACS patients were developed using 3 ML algorithms. We employed the ensemble learning random forest (RF) model, the Naive Bayes (NB) model and the rule-based projective adaptive resonance theory (PART) model. These models were compared to one another and to two conventional validated risk scores; the Global Registry of Acute Coronary Events (GRACE) risk score and Thrombolysis in Myocardial Infarction (TIMI) risk score. Out of the 500 patients included in our study, 164 (32.8%) patients presented with unstable angina, 148 (29.6%) patients with non-ST-elevation myocardial infarction (NSTEMI) and 188 (37.6%) patients were having ST-elevation myocardial infarction (STEMI). 64 (12.8%) patients died in-hospital and the rest survived. Performance of prediction models was measured in an area under the receiver operating characteristic curve (AUC) ranged from 0.83 to 0.93 using all available variables compared to the GRACE score (0.9 SD 0.05) and the TIMI score (0.75 SD 0.02). Using QTc as a stand-alone variable yielded (0.67 SD 0.02) with a cutoff value 450 using Bazett’s formula, whereas using QTc in addition to other variables of personal and clinical data and other ECG variables, the result was 0.8 SD 0.04. Results of RF and NB models were almost the same, but PART model yielded the least results. There was no significant difference of AUC values after replacing the missing values and applying class balancer. Conclusions The proposed method can effectively predict patients at high risk of in-hospital mortality early in the setting of ACS using only clinical and ECG data. Prolonged QTc interval can be used as a risk predictor of in-hospital mortality in ACS patients.

The Roles of Vitamin D Levels, Gla-Rich Protein (GRP) and Matrix Gla Protein (MGP), and Inflammatory Markers in Predicting Mortality in Intensive Care Patients: A New Biomarker Link?

Objectives: Identifying reliable biomarkers to predict mortality in critically ill patients is crucial for optimizing management in intensive care units (ICUs). Inflammatory and metabolic markers are increasingly recognized for their prognostic value. This study aims to evaluate the association of various inflammatory and metabolic markers with ICU mortality. Methods: This prospective observational study was conducted from January 2023 to January 2024 in the City Hospital’s ICU. A total of 160 critically ill patients were enrolled. Laboratory parameters, including white blood cell (WBC) count, red cell distribution width (RDW), platelet count, neutrophil count, mean platelet volume (MPV), monocyte count, lymphocyte count, procalcitonin (PCT), C-reactive protein (CRP), calcium (Ca++), and vitamin D levels, were analyzed. Additionally, ratios such as the platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), systemic inflammatory index (SII), and pan-immune-inflammation value (PIV) were calculated. Plasma levels of Gla-rich protein (GRP) and dephosphorylated uncarboxylated matrix Gla protein (dp-ucMGP) were measured using ELISA. Results: The mean age of the patients included in the study was 60.5 ± 15.8 years. Cardiovascular disease was present in 72 patients (45%), respiratory system disease in 58 (36%), and chronic kidney disease (CKD) in 38 (24%). Additionally, 61 patients (38%) had diabetes, and 68 (42%) had hypertension. Inflammatory markers, including PLR, NLR, and PIV, were all significantly higher in non-survivors, while calcium and vitamin D levels were lower (p < 0.05). Higher WBC, RDW, neutrophil count, PLR, NLR, PIV, CRP, procalcitonin, GRP, and dp-ucMGP levels were positively correlated with longer hospital stays and increased mortality. In contrast, platelet and lymphocyte counts were negatively correlated with both outcomes (p < 0.05). Vitamin D levels showed an inverse relationship with both hospital stay and mortality, indicating that lower levels were associated with worse outcomes (p < 0.05). In multiple logistic regression analysis, elevated WBC count (OR = 1.20, p = 0.02), RDW (OR = 1.35, p = 0.01), neutrophil count (OR = 1.25, p = 0.01), MPV (OR = 1.20, p = 0.02), PLR (OR = 1.30, p = 0.01), NLR (OR = 1.40, p = 0.001), PIV (OR = 1.50, p = 0.001), CRP (OR = 1.32, p = 0.01), procalcitonin (OR = 1.45, p = 0.001), GRP (OR = 1.40, p = 0.001), and dp-ucMGP (OR = 1.30, p = 0.001) levels were significantly associated with increased mortality. Conclusions: Inflammatory and metabolic markers, particularly NLR, PLR, PIV, GRP, and dp-ucMGP, are strong predictors of mortality in ICU patients. These markers provide valuable insights for risk stratification and early identification of high-risk patients, potentially guiding more targeted interventions to improve outcomes.

HPB SO29 - Outcomes of Percutaneous Image-Guided and Laparoscopic Cholecystostomies in High-Risk Patients With Acute Calculus Cholecystitis: A Five-Year District General Hospital Experience

Abstract Background Acute cholecystitis (AC), inflammation of the gall bladder, is one of the most common emergency surgical presentations. In the UK, approximately 15% of the population is estimated to have gallstones, and approximately 20% of them can develop AC. Laparoscopic cholecystectomy (LC) is considered the definitive management of AC. However, cholecystectomy carries a very high risk of morbidity and mortality in high-risk frail patients with multiple comorbidities who are deemed unfit for surgery. Percutaneous cholecystostomy (PC), both image-guided and laparoscopic, is generally acknowledged as an interim treatment measure before definitive management, which is the LC. Method This retrospective study from the Royal Albert Edward Infirmary in Wigan, UK, analyzed medical records of patients who underwent percutaneous cholecystostomy (PC) between January 2017 and December 2022. Excluded were patients with prior hepato-pancreato-biliary malignancy, those who had open cholecystostomy, or those with abdominal ascites. Data collected included age, gender, American Society of Anaesthesiologists (ASA) grades, procedure success rates (temporary or definitive), hospital stay duration, 30-day and 1-year mortality rates, timing of the procedure, and long-term complications, particularly those related to cholecystostomy tube dislodgment or blockage. Results In this study, 27 patients who underwent percutaneous cholecystostomy (PC) were divided into two groups: Group A (10 patients) had laparoscopic cholecystostomies, and Group B (17 patients) had ultrasound-guided cholecystostomies. The mean ages were 66.7 for Group A and 75.1 for Group B. Most patients were in ASA groups III (14) and IV (10). About 74% had procedures during the day, 26% at night. The mean hospital stay was 13.5 days. Around 55% had elective laparoscopic cholecystectomy (LC) as definitive management. Two patients died within 30 days, and eight within a year. About 40% experienced tube dislodgment or blockage complications. Conclusion This study concludes that PC, using both laparoscopic and US-guided techniques, can serve as an interim as well as a definitive measure, particularly in patients who are at high risk for anesthesia and the procedure itself and have multiple comorbidities.

Low-dose trimethoprim-sulfamethoxazole treatment for Pneumocystis pneumonia: a systematic review and meta-analysis

BackgroundThe recommended standard treatment for Pneumocystis jirovecii pneumonia (PJP) is high-dose trimethoprim-sulfamethoxazole (TMP-SMX) (15–20 mg/kg/d TMP). However, the standard regimen may cause a high incidence of dose-related adverse events (AEs). Therefore, we aimed to conduct a systematic review and meta-analysis to evaluate the efficacy and safety of low-dose TMP-SMX regimens (<15 mg/kg/d of TMP) compared with the standard regimen in patients with PJP.MethodsWe searched PubMed, Embase, and the Cochrane database for relevant articles from inception to 10 March 2024. Studies were included if they focused on PJP patients receiving a low-dose TMP-SMX regimen compared with a standard regimen. The primary outcome was mortality. We assessed study quality and performed subgroup analysis and sensitivity analysis to explore potential heterogeneity among the included studies.ResultsSeven studies were included. Overall, the low-dose regimen significantly reduced the risk of mortality (odds ratio [OR] = 0.49; 95% CI, 0.30–0.80; I2 = 16%; P = 004). This finding was confirmed in further sensitivity and subgroup analyses. The low-dose regimen also significantly reduced total AEs (OR = 0.43; 95% CI, 0.29–0.62; I2 = 0%; P < 0.0001), and improved the incidence of most specific AEs (ORs ranged from 0.13 to 0.89). In addition, the low-dose regimen had significantly more patients completing the initial regimen (P = 0.002), fewer patients requiring dose reductions (P = 0.04), and almost significantly fewer patients requiring a switch to a second-line regimen (P = 0.06).ConclusionThe limited available evidence suggests that a low-dose TMP-SMX regimen significantly reduced mortality and total AEs in PJP patients. Thus, it is one of the potentially promising therapies to PJP and more high-quality and multi-center randomized trials should be conducted in the future.

EGS SO35 - Emergency laparotomies in the elderly: A patient perspective

Abstract Background Emergency laparotomy is known to convey worse morbidity and mortality for elderly patients. Despite a growing elderly population, there is a limited understanding of the patient experience in emergency laparotomy. This study aims to assess patient satisfaction following emergency laparotomy. Method Patients were identified from the National Emergency Laparotomy Audit (NELA) database, who were aged 80 and above, and underwent surgery between: January 2020 and August 2023 at Torbay Hospital. Of the patients who survived to discharge, a telephone-based interview was undertaken in January 2024. Exclusion criteria included: confusion, severe illness and relook laparotomy. Data was collected on functional status and satisfaction with the procedure. Patients were also asked what they wished they known prior to the operation. Post-operative outcomes were assessed in a separate study. Results 132 cases were undertaken in this period. 72 cases met inclusion criteria. We achieved a 54% response rate. 59% of respondents were living independently post operatively and had no functional decline. 92% of respondents were happy to have had the operation and if given the opportunity again would still have had the procedure. Patients were overall very happy with the information offered prior to the procedure, 8% felt they had no alternative option. One patient was not satisfied with the follow up received. Conclusion Although emergency laparotomy in the elderly is high risk, our data demonstrate excellent patient satisfaction. This study provides a better understanding of what is important to patients; this should be considered in the consent process and communication.

Impaired Kidney Function and 10-Year Outcome After Percutaneous Coronary Intervention—Interaction with Age, Sex, Diabetic Status and Clinical Presentation

Background: Limited evidence exists regarding the association of chronic kidney disease (CKD) with long-term outcomes following percutaneous coronary intervention (PCI). We aimed to assess the association of CKD with 10-year outcome after PCI. Methods: This study included 5571 patients with coronary artery disease (CAD) undergoing PCI. Patients were categorized in groups according to the estimated glomerular filtration rate (eGFR) values: eGFR ≥ 90 mL/min/1.73 m2, (normal kidney function), 60 to <90 mL/min/1.73 m2 (mild kidney impairment), 30 to <60 mL/min/1.73 m2 (mild-to-moderate and moderate-to-severe kidney impairment) and <30 mL/min/1.73 m2 (severe kidney impairment). The primary endpoint was all-cause mortality at 10 years. Results: All-cause deaths occurred in 155 patients (86.3%) with eGFR < 30 mL/min/1.73 m2, 602 patients (59.1%) with eGFR 30 to <60 mL/min/1.73 m2, 775 patients (31.3%) with eGFR 60 to <90 mL/min/1.73 m2 and 220 patients (15.8%) with eGFR ≥ 90 mL/min/1.73 m2 (adjusted hazard ratio = 2.16, 95% confidence interval 1.84 to 2.54, p < 0.001, for 30 mL/min/1.73 m2 decrement in the eGFR). There were CKD-by-age (Pint < 0.001) and CKD–by-clinical presentation (Pint = 0.017) interactions showing a stronger association of CKD with mortality in younger patients and those presenting with acute coronary syndromes. The C statistic of the multivariable model for mortality increased from 0.748 [0.737–0.759] to 0.766 [0.755–0.777] (p < 0.001) after the inclusion of eGFR in the model. Conclusions: In patients with CAD undergoing PCI, CKD was associated with higher mortality at 10 years compared with patients with preserved renal function. The association between CKD and mortality was stronger in patients of younger age and those presenting with acute coronary syndromes.

Differences in association between hypoalbuminaemia and mortality among younger versus older patients on haemodialysis

Abstract Background Ageing often impacts on biomarker production. Yet, clinical/optimal thresholds to guide clinical decisions do not consider this. Serum albumin decreases with age, but hypoalbuminaemia is defined as serum albumin <4.0 g/dL. This study explores whether age might affect serum albumin levels and its association with mortality in haemodialysis patients. Methods COSMOS (Current management Of Secondary hyperparathyroidism: a Multicentre Observational Study) is a prospective, open cohort, observational study of haemodialysis patients followed for 3 years. Binary logistic and linear regression were used to analyse the association between age and hypoalbuminaemia or serum albumin (continuous). Cox proportional hazard multivariate regression was used to examine the relationship between hypoalbuminaemia and mortality in patients younger and older than 65 years. Time-dependent receiver operating characteristic (ROC) curves were used to assess the discriminatory ability of serum albumin and optimal thresholds for predicting mortality. Results The present analysis included 5,585 patients. The odds of experiencing hypoalbuminaemia increased with age (adjusted odds ratios = 1.56[95%CI: 1.31-1.86], 1.89[95%CI: 1.59-2.24], 2.68[95%CI: 2.22-3.23] for 56-65, 66-75 and > 75 years respectively (reference ≤55 years; p-value for trend: <0.001)). Survival analysis showed that the association between hypoalbuminaemia and mortality was weaker in patients aged ≥65 compared to <65 years (Hazard Ratios: 1.36[95%CI: 1.17-1.57] and 1.81[95%CI:1.42-2.31] respectively; p-value for interaction 0.004). The ability of albumin levels to predict mortality was consistently higher in younger patients. Optimal albumin thresholds for predicting mortality were 3.7 g/dL in patients younger than 65 years and 3.5 g/dL in patients 65 years and older. Conclusions Ageing is accompanied by lower albumin levels, and the association between hypoalbuminaemia and mortality may be modified by age. Different clinical thresholds that consider age may better discriminate risks associated with hypoalbuminaemia.

The state of cancer care in Russia: malignant tumors of the skin (C44). Prevalence, quality of accounting, age characteristics, localization and histological structures (clinical and population study). Part 1.

This work represents a clinical-population study of the state of oncological care in Russia, focused on malignant skin neoplasms (C44). The study analyzes data on the prevalence of this disease, the quality of case accounting, age characteristics, and the localization and histological structure of tumors. The aim of this research is to continue the investigation into the patterns of prevalence of skin neoplasms (C44), assess the quality of primary accounting, and evaluate the impact of the coronavirus infection epidemic on analytical indicators of prevalence and patient survival. The conducted study confirmed the trend of increasing morbidity and decreasing mortality from skin neoplasms (C44) among the population of Russia and the Northwestern Federal District of the Russian Federation. A clear positive dynamics in the quality of accounting is observed. Special attention is given to the specifics of morbidity changes in neoplasms (C44) considering each age group of the population of Russia. At the population level, the age-specific mortality of patients is presented for each year of observation, analyzed in the context of five-year cohort groups. For the first time, a trend has been identified showing an increase in annual mortality from skin neoplasms (C44) after the sixth year of observation following the treatment of patients.

HPB SO12 - Comparison of outcomes between stapled closure and sutured closure of pancreatic stump following robotic distal pancreatectomy

Abstract Background Postoperative pancreatic fistulas (POPFs) are associated with high patient mortality and morbidity. There are multiple approaches in managing pancreatic stumps following distal pancreatectomy. We compared the outcomes between sutured closure and stapled closure following robotic distal pancreatectomy and splenectomy, and the associated cost difference between the two techniques. Method We retrospectively analysed consecutive robotic distal pancreatectomy and splenectomy cases between October 2022 and January 2024 in a single United Kingdom tertiary hospital. Stapled closure was the initial standard approach. Sutured closure utilising 3/0 Prolene was regularly performed from July 2023. The study cohort was divided into these two groups and outcomes were compared. Primary outcome was POPF rates and secondary outcomes included postoperative length of stay (LOS), 30-day readmission rates and postoperative complications graded by Clavien-Dindo classification (CDC). Equipment costs for the respective procedures were obtained from hospital procurement team. Results 36 patients were reviewed; 14 (38.9%) were stapled and 22 (61.1%) were sutured. Patient characteristics including mean age, gender and ASA grade were similar in both groups. 23/36 (63.9%) patients had confirmed malignancy on postoperative histopathology – similar distribution in both groups. 6/14 (42.9%) in the stapled group vs 4/22 (18.2%) in the sutured group developed POPF Grade B (p=0.14). LOS, 30-day readmission and CDC complication rates were similar in both groups. Median costs were £2236.40 and £1541.86 in the stapled and sutured groups respectively. Conclusion Sutured closure of pancreatic stump yielded similar outcomes to stapled closure following robotic distal pancreatectomy, associated with a significant cost saving in favour of sutured closure.

Abstract 4145889: Association between Pulmonary Artery Elastance and all cause mortality in patients with Heart Failure: A Meta-Analysis

Background: Pulmonary Artery Elastance (PAE) is an echocardiographic value commonly calculated in Heart Failure (HF) patients. It is presumed to be associated with mortality and adverse outcomes. We aim to evaluate pulmonary artery elastance (PAE) as a predictor of all-cause mortality in heart failure (HF) patients Methods: A comprehensive literature review was conducted on PubMed and Google Scholar from inception till May 2024 for articles relevant to the mortality outcomes in HF patients with respect to pulmonary arterial elastance as one of their predictors. Data were extracted independently by four different reviewers. We used a fixed-effects model meta-analysis model to evaluate and pool the outcomes in association with PAE and all-cause mortality. Further assessment of the outcomes was performed by sensitivity analysis with a one-study removal method and meta-regression analysis. Results: Out of 63 studies, 4 studies with 759 patients were included in our meta-analysis. Mean age ranged from 54 to 65 years. We found there was a statistically significant association between pulmonary artery elastance and all-cause mortality (OR: 1.12, 1.06 - 1.19, p < 0.0001] (Figure 1a). Sensitivity analysis with one-study removal showed overall effects in the meta-analysis still lean towards supporting PAE as the predictor for ACM (Figure 1b). Meta-regression analysis with age (Figure 1c), sex and other supportive variables did not show statistically significant associated confounders. Conclusion: This meta-analysis establishes a significant association between elevated PAE and increased risk for all-cause mortality in HF patients. These results suggest PAE could be a strong predictor for all-cause mortality in HF patients. Further research is needed to provide a more comprehensive understanding of the predictive value of PAE for HF patients. The association between PAE and mortality could provide significant insights that could influence clinical practice and improve patient outcomes in HF.

Abstract 4137939: Mosaic loss of Y chromosome is associated with increased all-cause mortality in patients with ST-segment elevation myocardial infarction

Introduction: Mosaic loss of Y chromosome (LOY), a common subtype of somatic mosaicism, is characterized as loss of the entire Y chromosome in a mosaic manner and increases with age. Accumulating evidence has manifested the positive link between LOY and shorter life expectations in elderly men as well as common age-associated diseases, such as cancer and cardiovascular diseases. Experimental studies also demonstrated that hematopoietic LOY in mice induced cardiac fibrosis and led to increased mortality. However, little is known about LOY and prognosis of ST-segment elevation myocardial infarction (STEMI). Hypothesis: We hypothesized that LOY may be associated with lower survival rate of patients with STEMI. Aims: Investigating the impact of LOY in peripheral blood cells on prognosis of patients with STEMI. Methods: This study prospectively enrolled 928 males and 272 females undergoing primary percutaneous coronary intervention for STEMI. LOY was measured in 928 males using droplet digital polymerase chain reaction technique. Results: During a median follow-up of 3.99 years, 93 males (10.0%) and 45 females (16.5%) died. After adjusting for traditional cardiovascular risk factors, the risk of all-cause mortality in males with LOY ≥ 18% (the 90th percentile of LOY) increased to 2.45 (95% confidence intervals [CI]: 1.16–5.15, P = 0.018), 2.11 (95% CI: 1.11–4.01, P = 0.024), and 1.88 (95% CI: 1.02–3.45, P = 0.043) times during 1-, 2-, and 3-year follow-up, respectively, compared to males with LOY < 18%. Among males without prior MI, those with LOY ≥ 18% had an increased risk of all-cause mortality compared to those with LOY < 18% (adjusted hazard ratio 1.93, 95% CI: 1.01–3.67; P = 0.045); this was not observed for males with prior MI. Female patients had a 1.71-fold (95%CI: 1.04–2.81; P = 0.035) increased risk of all-cause mortality than males with LOY < 18%, whereas the risk was similar to males with LOY ≥ 18%. Conclusion: LOY was associated with an increased risk of all-cause mortality in male STEMI patients, particularly in those without prior MI. Detecting LOY in STEMI patients could help further refine sex differences in prognosis and assist in identifying male patients with better prognoses.

Abstract 4138252: Association between Pressure-Adjusted Heart Rate and Mortality in Cardiogenic Shock

Introduction: Among patients with cardiogenic shock (CS), high right atrial pressure (RAP) and low mean arterial pressure (MAP) are associated with in-hospital mortality. Pressure-adjusted heart rate (PAHR), defined as heart rate * RAP-to-MAP ratio (HR * [RAP/MAP]), integrates these parameters and has been used to identify cardiovascular dysfunction in critical illness. Higher PAHR values associate with higher surgical ICU mortality, but the prognostic significance of PAHR has not been assessed in cardiac intensive care unit (CICU) patients with CS. Hypothesis: We hypothesized that higher PAHR values are associated with higher risk of in-hospital mortality in patients with CS. Methods: The Critical Care Cardiology Trials Network (CCCTN) is a multinational registry of CICUs coordinated by the TIMI Study Group. Among CS admissions (2018-2023) undergoing invasive hemodynamic assessment within 24h of CICU admission, we calculated PAHR (in bpm) and assessed its relationship with in-hospital mortality. Patients on temporary mechanical circulatory support were excluded. Odds ratios were adjusted for age, sex, vasoactive-inotropic score (VIS), SCAI stage, and preceding cardiac arrest. Subgroup analyses stratifying by CS subtype were performed. Results: Among the 1411 CS admissions in the analysis cohort (mean age 61 years, 31% women), 18% had AMI-CS, 75% had HF-CS, and 7% had secondary CS. At the time of assessment (median 1.4h after CICU admission), 75% were on vasoactive support (median VIS 3.8). Median HR was 92 (Q1-Q3 77-109) bpm, RAP 15 (Q1-Q3 10-19) mmHg, MAP 75 (Q1-Q3 67-87) mmHg, and PAHR 17 (Q1-Q3 11-24) bpm. A stepwise gradient of higher in-hospital mortality with increasing PAHR values (p-trend <0.001; Fig ) was observed. In adjusted models, a higher PAHR was associated with higher in-hospital mortality (aOR per 10-bpm, 1.35 [95% CI, 1.15-1.58]), and had stronger prognostic associations with mortality than its individual hemodynamic components (Fig) . Conclusion: Higher PAHR is strongly associated with in-hospital mortality in CS patients. PAHR, a simple parameter which is readily calculable without needing a pulmonary artery catheter, may aid in identifying CS patients at higher risk of death.

Abstract 4141497: Left ventricular diastolic function by echocardiography is related to extracellular volume and is an independent predictor of mortality in patients with aortic regurgitation

Background: Cardiac catheterization along with cardiac biopsy studies have shown the presence of abnormally increased left ventricular (LV) chamber stiffness in patients with severe aortic regurgitation (AR) and its significant correlation with interstitial fibrosis. LV diastolic dysfunction (DD) is associated with increased mortality in several patient populations. However, there is a paucity of data on the association of DD with mortality in patients with AR. Hypotheses: 1 - LV DD is related to extracellular volume (ECV), imaging marker of interstitial fibrosis, by cardiac magnetic resonance imaging (CMR) 2 - LV DD by echocardiography is associated with mortality in patients with AR Methods: We studied patients with moderate or greater AR who underwent echocardiographic and CMR imaging within 12 months. We excluded patients with concomitant valve disease, prior valve intervention, cardiomyopathy deemed unrelated to AR, congenital heart disease and terminal conditions. The primary outcome was all-cause death. CMR was used to obtain LV volumes, EF and mass, AR severity, scar extent by delayed hyperenhancement, and ECV. DD was assessed by comprehensive echocardiography. Results: The study included 323 patients. Mean age was 61.9 ± 16.0 years and 22% were female. Median follow-up was 3.8 years, during which 65 patients died and 172 had aortic valve replacement. Median LV EF was 56 (47-65) %, AR volume on CMR was 40 (30-61) mL, and AR fraction was 40 (33-47) %. ECV progressively increased with higher grades of LV DD (Figure 1). Table 1 shows the univariate associations with mortality in the study. On multivariable analysis based on the Lasso variable selection process, Euroscore, Charlson comorbidity index, DD grade, and RAP were associated with total mortality. Conclusion: ECV by CMR progressively increases with higher grades of DD by echocardiography, and DD is independently associated with mortality in patients with AR.

Abstract 4138024: Identifying the Medications with the Greatest Reduction in Mortality in Coronary Artery Dissection

Introduction: Coronary artery dissection (CD) is a potentially fatal complication, usually arising either spontaneously or iatrogenically. Therefore, identifying treatment methods that reduce mortality is of great importance. The American College of Cardiology recommendations stipulate that patients who have experienced CD may benefit from beta-blocker therapy, as beta-blockers have been shown to reduce the incidence of recurrent CD. Currently, there is little published data in support of beta-blockers providing mortality reduction for CD. Given the significant risk of mortality from CD, we aimed to test the veracity of these recommendations using a retrospective multicenter study as well as having a main objective of exploring means to lower mortality in CD. Methods: We conducted a retrospective, multicenter cohort that identified 2,104 patients diagnosed with CD. We extracted the data from across 16 West Florida hospitals in between the years of 2017-2022. Our patients were identified and stratified based on common lab values and cardioprotective medications they were taking. Chi-square and binary logistic regression was used to calculate odds ratios for mortality. The odds ratio estimate for mortality was our primary outcome with attention given to factors that were associated with an increased or decreased likelihood of mortality in patients with CD. Results: Patients on beta-blockers, angiotensin converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) were the only variables that were statistically significant. Out of 2,104 patients, 1,562 patients were on beta-blockers (74.2%), and 921 were on an ACEi/ARB (43.8%). Our data revealed that the odds ratio for mortality in patients with CD while on beta blockers was 0.375 (p-value 0.0009, confidence interval 0.210-0.669), and while on ACEi/ARBs was 0.447 (p-value 0.0077, confidence interval 0.247-0.808). These results indicate a significant reduction in mortality in patients who are taking beta-blockers and/or ACEi/ARB medications after being diagnosed with CD. Conclusion: Our data can be viewed as supportive of the current recommendation for the primary use of beta-blockers in patients with spontaneous CD, as well as suggesting angiotensin receptor blockers and angiotensin-converting enzyme inhibitors as possible additional therapies

Outcomes of Concomitant Mitral Intervention in Hypertrophic Obstructive Cardiomyopathy Surgery?: A Systematic Review and Meta-Analysis of Contemporary Evidence

The 2020 American Heart Association Guidelines advise not to perform mitral valve replacement (MVR) during septal myectomy (SM) to alleviate outflow obstruction. This study aims to review outcomes after concomitant mitral valve (MV) intervention versus SM alone. We conducted a comprehensive literature search across Embase, PubMed, and Scopus. Studies published up to June 15, 2024 were considered. We included studies that compared SM alone to concomitant MV repair or replacement. Subgroup analyses based on MV intervention were performed. Seven studies met our criteria, including 1 randomized and 6 observational studies. The total sample size was 17,565 patients with hypertrophic cardiomyopathy (11,849 SM, 2303 SM + MVR, and 3390 SM + MV repair). Patients who underwent SM + MV intervention had more pronounced preoperative MV regurgitation. SM + MVR was associated with significantly higher early mortality [risk ratio (RR): 2.85, 95% confidence interval (CI): 2.37–3.43, P < 0.00001, I² = 0%]. However, there was no difference in early mortality in patients who underwent SM + MV repair compared with SM alone (RR: 1.14, 95% CI: 0.88–1.49, P = 0.33, I² = 0%). Thirty days systolic anterior motion was significantly lower in patients who underwent SM + MV repair compared with SM alone (RR: 0.15, 95%CI: 0.05–0.45, P = 0.0007). Peak pressure left ventricular outflow tract gradient was significantly lower in the SM + MV repair group compared with SM alone (mean difference: −3.47, 95% CI: −5.55 to −1.39, P = 0.001). Current observational evidence suggests an increased risk of in-patient mortality in patients who underwent SM + MVR. SM + MV repair did not affect early mortality but was linked to improved outcomes. Future comprehensive and matched studies are warranted.

Abstract 4119146: Pulmonary Artery Enlargement Predicts Mortality in Patients with Severe Aortic Stenosis after Transcatheter Aortic Valve Replacement.

Background: Pulmonary hypertension is associated with extensive remodeling of the pulmonary tree, with key finding the enlargement of the pulmonary artery (PA). Although the independent predictive value of the pulmonary hypertension in patients undergoing transcatheter aortic valve replacement for severe aortic stenosis has been clearly demonstrated, data about the potential predictive value of the pre-interventional PA enlargement on mortality are scarce. Research questions: The aim of the present study was to assess the prognostic significance of the pre-interventional PA enlargement, assessed by cardiac CT scan, in patients undergoing transcatheter aortic valve replacement for severe aortic stenosis. Methods: We conducted a retrospective study and recruited 337 patients with aortic stenosis, who underwent a right heart catheterization and a cardiac CT scan before the transcatheter aortic valve replacement. The cohort was divided in two groups according to the presence of an enlarged PA (PA e ), (main PA axial diameter ≥ 29 mm for males and ≥ 27 mm for females, n=192, mean age 83±6 years, 41% males) or not (PA n ), ( n=145, mean age 84±6 years, 46% males). The primary endpoint was all-cause mortality at 1 year. Results: Globally, a strong correlation between invasive mean PA pressure and main PA axial diameter was noted (Pearson r=0.393, p<0 .001). Compared to the PA n group, patients with enlarged PA exhibited higher 1 year mortality rates (hazard ratio 2.51, 95% CI: 1.1-6.04, p=0.027). The prognostic significance was even stronger after indexing the PA to the ascending aorta diameter (hazard ratio 3.82, 95% CI: 1.86-7.87, p<0.001, figure 1). Conclusions: Pre interventional PA enlargement, is strongly associated with 1-year all-cause mortality in patients undergoing transcatheter aortic valve. This may pave the way for a more precise non-invasive risk stratification in patients with severe aortic stenosis.

Abstract Su303: Afferent Rapid Response Limb Failure Prior to Non-ICU In-Hospital Cardiac Arrest and Associated In-Hospital Mortality

Introduction/Background: Rapid Response Teams (RRT) have been widely implemented to recognize and manage clinical deterioration outside of the intensive care unit (ICU). Hospital systems frequently rely on individual healthcare provider’s skill and attention to identify early deterioration and activate the appropriate clinical resources. This is referred to as the afferent limb, or triggering mechanism, of the Rapid Response system. Hypothesis: Afferent limb failure leads to delayed clinical intervention and potentially worse outcomes for patients that progress to in-hospital cardiac arrest (IHCA). Goals/Aims: The aim of this retrospective study was to identify if afferent limb failure, defined as failure to recognize two or more standardized early warning criteria in the 24 hours prior to non-ICU IHCA, is associated with increased in-hospital mortality when compared to patients with zero to one standardized early warning criteria. Methods: Non-ICU IHCAs over a 6-year period (January 1 st , 2018, to December 31 st , 2023) at a large academic medical center were reviewed using standardized criteria to determine 1) if any RRT activation criteria had been met in the 24 hours prior to non-ICU IHCA, 2) how many RRT criteria were met, 3) whether an RRT activation occurred, and 4) in-hospital mortality. Statistical analysis included a Chi-Square analysis and Pearson Correlation Coefficient. Results: We identified 386 adult non-ICU IHCAs, with 214 (55.4%) meeting at least two RRT criteria in the 24 hours preceding their non-ICU IHCA. In patients without a preceding RRT activation (N=313), there was significantly higher in-hospital mortality in patients who met two or more RRT criteria prior to their non-ICU IHCA than patients who met one or zero criteria (91/151, 60.2% vs 114/162, 70.3%, p < 0.05). We also found a weak but statistically significant correlation between the total number of RRT criteria met prior to IHCA and in-hospital mortality (r=0.1331, p < 0.05). Conclusion: Afferent limb failure is associated with higher in-hospital mortality in patients with multiple markers of clinical deterioration prior to non-ICU IHCA. There is also an association between in-hospital mortality and the total number of clinical deterioration criteria met prior to non-ICU IHCA.