Possible Predictors Of Mortality Research Articles

Patients Hospitalized for COVID-19 in the Periods of Delta and Omicron Variant Dominance in Greece: Determinants of Severity and Mortality.

Coronavirus disease 2019 (COVID-19) has been a pandemic since 2020, and depending on the SARS-CoV-2 mutation, different pandemic waves have been observed. The aim of this study was to compare the baseline characteristics of patients in two phases of the pandemic and evaluate possible predictors of mortality. This is a retrospective multicenter observational study that included patients with COVID-19 in 4 different centers in Greece. Patients were divided into two groups depending on the period during which they were infected during the Delta and Omicron variant predominance. A total of 979 patients (433 Delta, 546 Omicron) were included in the study (median age 67 years (54, 81); 452 [46.2%] female). Compared to the Omicron period, the patients during the Delta period were younger (median age [IQR] 65 [51, 77] vs. 70 [55, 83] years, p < 0.001) and required a longer duration of hospitalization (8 [6, 13] vs. 7 [5, 12] days, p = 0.001), had higher procalcitonin levels (ng/mL): 0.08 [0.05, 0.17] vs. 0.06 [0.02, 0.16], p = 0.005, ferritin levels (ng/mL): 301 [159, 644] vs. 239 [128, 473], p = 0.002, C- reactive protein levels (mg/L): 40.4 [16.7, 98.5] vs. 31.8 [11.9, 81.7], p = 0.003, and lactate dehydrogenase levels (U/L): 277 [221, 375] vs. 255 [205, 329], p < 0.001. The Charlson Comorbidity Index was lower (3 [0, 5] vs. 4 [1, 6], p < 0.001), and the extent of disease on computed tomography (CT) was greater during the Delta wave (p < 0.001). No evidence of a difference in risk of death or admission to the intensive care unit was found between the two groups. Age, cardiovascular events, acute kidney injury during hospitalization, extent of disease on chest CT, D-dimer, and neutrophil/lymphocyte ratio values were identified as independent predictors of mortality for patients in the Delta period. Cardiovascular events and acute liver injury during hospitalization and the PaO2/FiO2 ratio on admission were identified as independent predictors of mortality for patients in the Omicron period. In the Omicron wave, patients were older with a higher number of comorbidities, but patients with the Delta variant had more severe disease and a longer duration of hospitalization.

Serum C-peptide level and the risk of cardiovascular diseases mortality and all-cause mortality: a meta-analysis and systematic review.

Recently, the serum of C-peptide has been the focus of researchers as a possible predictor of mortality. However, the possible association of serum C-peptide with cardiovascular diseases (CVDs) mortality and all-cause mortality has not been clearly identified. This meta-analysis aimed to assess the relationship between serum C-peptide and the risk of CVDs mortality and all-cause mortality. A comprehensive and systematic search was performed in various important databases, including the PubMed, Web of Science, and Scopus to find relevant studies up to November 2022. The reported hazard ratio (HR) [95% confidence interval (CI)] for all studies was converted into log HR, and their SD was calculated. Then to compute the pooled HR, the random-effects model with inverse variance weighting method was performed. Twenty-three studies were included in the meta-analysis. Fourteen studies reported HR for all-cause mortality, and nine studies for CVDs-related mortality. The pooled results indicate a significant association between serum C-peptide and the risk of all-cause mortality (HR: 1.22; 95% CI: 1.12-1.32, I2 = 76.8%; P-value < 0.001). Also, higher serum C-peptide was related to the increased risk of CVDs mortality (HR: 1.38; 95% CI: 1.08-1.77, I2 = 81.8%; P-value = 0.012). Our investigation suggested that an increased level of serum C-peptide is associated with a higher risk of both CVDs and all-cause mortality. Further, large-scale studies and sufficient samples are recommended to present a convincing link between C-peptide and the risk of CVDs and all-cause mortality. identifier, CRD42022364842.

Factors Associated with Mortality in Patients with COVID-19 Receiving Prolonged Ventilatory Support.

Background: Since its emergence in early 2020, coronavirus disease 2019 (COVID-19)-associated pneumonia has caused a global strain on intensive care unit (ICU) resources with many intubated patients requiring prolonged ventilatory support. Outcomes for patients with COVID-19 who receive prolonged intubation (>21 days) and possible predictors of mortality in this group are not well established. Patients and Methods: Data were prospectively collected from adult patients with COVID-19 requiring mechanical ventilation from March 2020 through December 2021 across a system of 11 hospitals. The primary end point was in-hospital mortality. Factors associated with mortality were evaluated using univariable and multivariable logistic regression analyses. Results: Six hundred six patients were placed on mechanical ventilation for COVID-19 pneumonia during the study period, with in-hospital mortality of 40.3% (n = 244). Increased age (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.03-1.09), increased creatinine (OR, 1.40; 95% CI, 1.08-1.82), and receiving corticosteroids (OR, 2.68; 95% CI, 1.20-5.98) were associated with mortality. Intubations lasting longer than 21 days (n = 140) had a lower in-hospital mortality of 25.7% (n = 36; p < 0.001). Increasing Elixhauser comorbidity index (OR, 1.12; 95% CI, 1.04-1.19) and receiving corticosteroids (OR, 1.92; 95% CI, 1.06-3.47) were associated with need for prolonged ventilation. In this group, increased age (OR, 1.06; 95% CI, 1.01-1.08) and non-English speaking (OR, 3.74; 95% CI, 1.13-12.3) were associated with mortality. Conclusions: In-hospital mortality in mechanically ventilated patients with COVID-19 pneumonia occurs primarily in the first 21 days after intubation, possibly related to the early active inflammatory process. In patients on prolonged mechanical ventilation, increased age and being non-English speaking were associated with mortality.

Development and validation of prediction model using nursing notes on sentiment scores for prognosis of patients with severe acute kidney injury receiving continuous renal replacement therapy based on computational intelligence algorithms.

Currently, the prediction values of models for the prognosis of acute kidney injury (AKI) receiving continuous renal replacement therapy (CRRT) were ordinary and establishing a better prediction model is necessary. Nursing notes are an important predictor of in-hospital mortality in intensive care unit (ICU) patients. This study established prognostic prediction models for AKI patients receiving CRRT especially using nursing notes. Totally, 682 AKI patients undergoing CRRT were included. AKI was diagnosed based on Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Four hundred and twelve patients lacking nursing notes data were excluded. Finally, 270 patients were included and randomly divided into a training set (n=189) and a testing set (n=81) at a ratio of 7:3. Univariate analysis explored the possible predictors of mortality in AKI patients receiving CRRT. Random forest models and broad learning system (BLS) models (with or without sentiment scores) were respectively constructed in the training set and verified in the testing set. The performances of the models were assessed by the sensitivity, specificity, and area under the curve (AUC). For the random forest model including the sentiment scores, the AUC was 0.86 (95% CI: 0.81-0.91), the sensitivity was 0.72 (95% CI: 0.63-0.80), and the specificity was 0.87 (95% CI: 0.80-0.94) in the training set and the AUC was 0.78 (95% CI: 0.68-0.88), the sensitivity was 0.65 (95% CI: 0.49-0.80), and the specificity was 0.75 (95% CI: 0.62-0.88) in the testing set. For the BLS model including the sentiment scores, the AUC was 0.87 (95% CI: 0.82-0.92), the sensitivity was 0.95 (95% CI: 0.91-0.99) and the specificity was 0.48 (95% CI: 0.38-0.59) in the training set and the AUC was 0.82 (95% CI: 0.73-0.91), the sensitivity was 0.41 (95% CI: 0.25-0.56) and the specificity was 0.98 (95% CI: 0.93-1.00) in the testing set. The BLS models including the sentiment scores might offer a tool for quickly identifying patients AKI patients receiving CRRT with high risk of mortality and providing timely interventions to them for improving their prognosis.

Predictors of Mortality and Amputation in Patients With Necrotizing Soft Tissue Infections of the Upper Extremity

Necrotizing soft tissue infection (NSTI) of the upper extremity is characterized by rapid progression, local tissue necrosis, systemic toxicity, and a high mortality rate. The negative consequences of debridement are balanced against preservation of life and limb. The primary objective of this study was to identify predictors of mortality in upper extremity NSTI. Secondary objectives were to identify predictors of amputation, final defect size, length of stay, and readmission within 30 days. An institutional registry for patients with NSTI was retrospectively queried from a single tertiary center covering a large referral population. Data on confirmed upper extremity NSTI were used to determine patient characteristics, infection data, and operative factors. Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) and Quick Sequential Organ Failure Assessment (qSOFA) scores were calculated from primary data to provide a measure of clinical severity. Bivariate screening identifying possible predictors of mortality and multivariable regression was performed to control for confounding. Similar analyses were performed for amputation, final defect size, and readmission within 30 days. A total of 99 patients met the study criteria. In-hospital mortality occurred in 12 patients, and amputation was performed in 7 patients. Etiology, causative organism, and clinical severity scores were variable. Logistic regression showed mortality to be independently predicted by vasopressor dependency outside of operative anesthesia. The relatively low number of case events, limited sample size, and multiple comparisons limited the evaluation of lesser predictor variables. The LRINEC score did not strongly predict amputation or death in this series. Necrotizing soft tissue infection of the upper extremity carries risk of mortality and amputation, and effective treatment requires prompt recognition, early goal-directed resuscitation, and early debridement. The strongest independent predictor of in-hospital mortality was vasopressor dependence outside operative anesthesia. The LRINEC score did not strongly predict death or amputation in upper extremity NSTI. Prognostic IV.

Elevated AST/ALT ratio is associated with all-cause mortality and cancer incident.

BackgroundThe aspartate transaminase (AST)‐to‐alanine aminotransferase (ALT) ratio, which is used to measure liver injury, has been found to be associated with some chronic diseases and mortality. However, its relevance to cancer incidence resulting from population‐based prospective studies has rarely been reported. In this study, we investigated the correlation of the AST/ALT ratio as a possible predictor of mortality and cancer incidence.MethodsA total of 9,946 participants fulfilled the inclusion criteria for a basic public health service project of the Health Checkup Program conducted by the BaiYun Community Health Service Center, Taizhou. Deceased participants and cancer incident cases were from The Taizhou Chronic Disease Information Management System. Odds ratios (ORs) and interval of quartile range (IQR) computed by logistic regression analysis and cumulative incidence rate were calculated by the Kaplan–Meier survival method and compared with log‐rank test statistics.ResultsSerum ALT and AST levels were both increased in patients with chronic diseases, but the ratio of AST/ALT was generally decreased. The cancer incident cases (488 new cases) had a greater baseline ratio (median =1.23, IQR: 0.96–1.54) than noncancer cases (median =1.15, IQR: 0.91–1.44). Compared to the first quartile of the AST/ALT ratio, the population in the top quartile had a higher cumulative cancer incidence rate (7.54% vs. 4.44%) during follow‐up period. Furthermore, an elevated AST/ALT ratio increased the risk of all‐cause mortality.ConclusionsThe ratio of AST/ALT is a potential biomarker to assess healthy conditions and long‐term mortality. Especially for cancer, the AST/ALT ratio not only increases at baseline but also predicts the future development of cancer. The clinical value and potential mechanism deserve further research.

Mortality in Patients after Diabetic Charcot Foot-Related Procedures

Category:Diabetes; Hindfoot; Midfoot/ForefootIntroduction/Purpose:Diabetic Charcot foot is a chronic and progressive disease, following neuropathic loss of protective sensation and causing destruction of the joints. It is classically identified through a rocker-bottom deformity and may also present with a collapse of the medial arch, bony prominences, and ligamentous instability. Charcot leads to further morbidities, and patients may require surgeries including below the knee amputations or limb salvage reconstruction to treat the disease if conservative treatments fail. Previous literature demonstrated that foot ulceration is associated with mortality in diabetic patients, but no clear association between Charcot diagnosis and mortality has been identified. The purpose of this study was to investigate the mortality in patients diagnosed with acute diabetic Charcot foot.Methods:After institutional review board approval, all patients at a single institution that underwent an orthopaedic surgery for the treatment of Charcot during 2015-2020 were queried using hospital and public records. Demographic data, as well as the 30- day, 90-day, 1-year, and 5-year mortality were recorded.Results:79 patients were identified, with 57 (72%) males and 22 (28%) females with Charcot-related surgeries between 2015 and 2020. At the time of surgery, the average age was 58.2 (28-83) years. At the time of analysis, 61 (77%) patients were still living, but 18 (23%) patients were deceased with mortality within 30 days (1), 90 days (5), 1 year (9), and 5 years (18) of the Charcot-related procedure. For deceased patients, the average age of death was 59.6 years (30-83 years). The average number of days post- operation until death was 460 days (23-1613 days).Conclusion:Diabetic Charcot foot is a serious and debilitating complication of diabetic neuropathy. This data demonstrates that 23% of patients analyzed expired an average of 1.26 years after Charcot-related surgery. In addition, patients that were deceased were an average of 59.6 years of age, suggesting that Charcot may be associated with early mortality. Future studies will include an analysis of possible predictors of mortality for patients diagnosed with Charcot foot to evolve clinical and surgical management of patients.

Ethnic Genetic Prevalence of Angiotensin-Converting Enzyme (Insertion/Deletion) Polymorphism and COVID-19 Risk in the Jordanian Arab Population: A Possible Predictor of Mortality and Morbidity

Ethnic Genetic Prevalence of Angiotensin-Converting Enzyme (Insertion/Deletion) Polymorphism and COVID-19 Risk in the Jordanian Arab Population: A Possible Predictor of Mortality and Morbidity

Clinical manifestations, diagnosis, and treatment outcome of CNS aspergillosis: A systematic review of 235 cases

Aspergillus is a ubiquitous ascomycete that can cause a variety of clinical presentations depending on immune status. Central nervous system aspergillosis is a fatal disease with non-specific clinical features. The aim of this systematic review was to evaluate the epidemiology, clinical features, diagnosis and therapeutic interventions in CNS aspergillosis patients. We also aimed to examine the possible predictors of mortality in neuroaspergillosis. Literature search was performed in Medline, PubMed, and Google scholar and all patients≥18 years with proven CNS aspergillosis were included. A total of 175 articles (235 patients) were included in the final analysis. Their mean age was 51 years and the majority were male (57.4%). Overall case-fatality was 45.1%. Aspergillus fumigatus was the most common species (70.8%) followed by A. flavus (18.6%). Corticosteroids (22.6%), malignancy (19.1%) and diabetes mellitus (14%) were the most common risk factors. Neuroimaging findings included cerebral abscess (70.2%), meningitis (14%), infarction (13.2%) and mycotic aneurysm (8.9%). Disseminated disease (29.2% vs 17.8%, p 0.03), CSF hypoglycorrhachia (48.1% vs 22.2%, P: 0.001) and heightened CSF galactomannan (3.62 vs 2.0ng/ml, p 0.05), were the factors associated with poor outcome in neuroaspergillosis. Persons infected with Aspergillus flavus (13.1% vs 3.1%, P: 0.01), and having been treated with Voriconazole (51.9% vs 29.2%, P: 0.004) were more likely to survive. Our review will provide insight into the different spectrums of CNS aspergillosis. Notwithstanding the promising role of Voriconazole, future work is required to ascertain the role of combination antifungal therapy.

Adrenal Hyperplasia as Possible Predictor of Mortality in Patients Admitted for Suspected SARS-Cov-2 Infection: A Prospective Study

A large percentage of patients affected by SARS-CoV-2 disease (COVID) have associated comorbidities such as arterial hypertension, obesity, diabetes mellitus and thrombophilia. On the contrary, the prevalence in COVID patients of diseases of the adrenal glands has not been reported. Since the visualization of the adrenal glands is almost always available in chest CT performed in patients with suspected or confirmed SARS-CoV-2 infection, the evaluation of the frequency and characteristics of morphological disorders of the adrenal masses in such patients appears of interest. We carried out a prospective consecutive series of 402 patients (M 222, 55.2%; F 180, 44.8%) with a median age of 76 years (IQR 64–84 years), admitted in the emergency department for suspected SARS-CoV-2 infection. One hundred patients had a PCR-confirmed diagnosis of infection on a naso-pharyngeal swab (24.9%). All patients underwent a chest MDCT study including the adrenal region and clinical assessment of co-morbidities. Compared to subjects without confirmed disease, COVID patients had more frequently close contact with other positive subjects (24% vs 4.6%, p <0.001), typical symptoms (68% vs 28.5%, p <0.001), and suggestive chest CT findings (90% vs 31.1%, p <0.001). We found altered adrenal morphology in 100 patients (24.9%): 62 subjects had adrenal hyperplasia, which was unilateral in 42 of them (67.7%) and bilateral in 20 (32.3%), while 38 patients had discrete adrenal nodules, unilateral in 34 of them (89.4%) and bilateral in 4 (10.6%). The median size of adrenal nodules was 16 mm (10–50 mm) with a median density of 10 HU (-41 - 42 HU). In 17 patients with adrenal hyperplasia, a previous CT was available for comparison: in all cases an increase in thickness was evident at admission (from 1 to 15 mm, with a median of 1.95 mm increase). COVID patients had a higher frequency of adrenal nodules (12% vs 8.6%, p=NS). Sixty-three patients (16%) died. They were older (80 vs 74 years, p = 0.001), had a higher frequency of adrenal hyperplasia (25% vs 14%, p = 0.03), more frequent active cancer disease (37% vs 19%, p = 0.003) and COVID (23% vs 13.2%, p = 0.02). In a multivariate model, adrenal hyperplasia is an independent risk factor for mortality (OR 2.52, 1.15–5.55, p=0.02), as well as age (OR 1.04, 1.01–1.07, p=0.005), active oncological disease (OR 3.06, 1.44–6.49, p=0.004), and COVID (OR 2.88, 1.38–6.01, p=0.005). This is the first study reporting the prevalence of morphological alterations of adrenal glands in suspected COVID patients. The frequency of discrete adrenal nodules (9.5%) is in line with the high prevalence of adrenal incidentalomas in elder subjects. The high frequency of adrenal hyperplasia associated with increased risk of mortality suggests that this may be the consequence of an exaggerated activation of the HPA axis due to a highly stressful condition.

Patients undergoing urgent trans-aortic valve implantation suffer from an increased mortality rate

Abstract Introduction Information on the outcome of urgent Transcatheter valve implantations (TAVI) is scarce, but available data suggest that it could be a reasonable option for the treatment of decompensated severe aortic valve stenosis. The prospects of an all-comer urgent population, however, are unknown. Here we report our experience with clinically indicated urgent TAVI implantation in an unselected patient population with severe aortic valve stenosis (AS). Purpose To compare the outcome of patients undergoing urgent or elective TAVI and to identify potential predictors of outcome. Methods A retrospective, single centre study of AS patients undergoing femoral or apical TAVI between 01. 01.2013 and 30.09.2018 was performed. Demographic information, medical history, clinical and procedural data were collected from the local electronic database. Urgent implantation was defined as accelerated, in-hospital patient preparation and urgent device placement following an acute admission. Survival was investigated with Kaplan-Meier survival analysis and log-rank test. Regression analysis was performed to identify possible predictors of mortality. Results During the study period TAVI was performed in 631 patients, of whom 53 (8.4%) underwent urgent TAVI. In the case of urgent procedures, the median admission-to-procedure time was 18 [10–29] days. Age, gender and the prevalence of diabetes mellitus, chronic obstructive lung disease (COPD) and a glomerular filtration rate of ≤30ml/min was comparable among the groups. Patients in the urgent group had a lower BMI (26 [23–28] vs. 27 [24–30]; p&amp;lt;0.05), had more frequently an ejection fraction &amp;lt;30% (30% vs 4%p&amp;lt;0.001) and a higher Euroscore II (5.3 [3.4–10.9]% vs 2.9 [1.7–4.5]%; p&amp;lt;0.001). The rate of apical implantation and post-operative stroke, pacemaker implantation and renal failure did not differ between the groups. Urgent patients, however, needed longer post-procedural hospitalization (6 [4–9] vs 4 [3–6] days; p&amp;lt;0.001) and had higher in-hospital (11.3% vs 3,1%; &amp;lt;0.001) and one-year mortality rates (28.3% vs 8.5%; p&amp;lt;0.001). Urgency was an independent predictor of overall one-year mortality (HR 3.0, p=0.001) and worsened the survival of the individuals who were discharged from the hospital (out-of-hospital mortality at one-year; HR 2.8, p=0.011), but had no effect on in-hospital mortality. In-hospital mortality was mainly determined by apical access (OR 3.1; p=0.016) and major post-operative stroke (OR 8.8.; p=0.006), with both worsening overall 1-year survival too (HR 1.8 for apical access and 4.8 for stroke; p&amp;lt;0.05). Mortality after a successful hospital discharge was increased not only by urgency (HR 2.8, p=0.011), but by COPD (HR 2.1; p=0.04) and prolonged post-operative hospitalization (HR 1.05/day; p=0.001) as well. Conclusion Stabilizing AS patients can mitigate the effect of urgency on peri-procedural survival. Urgency remains, however, an important determinant of one-year TAVI outcome. Funding Acknowledgement Type of funding source: None

EEG findings and clinical prognostic factors associated with mortality in a prospective cohort of inpatients with COVID-19

PurposeOur objective is to describe the most prevalent electroencephalographic findings in COVID-19 hospitalized patients, and to determine possible predictors of mortality including EEG and clinical variables. MethodsA multicentric prospective observational study in patients with COVID-19 requiring EEG during hospitalization. ResultsWe found 94 EEG from 62 patients (55 % men, mean age 59.7 ± 17.8 years) were analyzed. Most frequent comorbidity was cardiac (52 %), followed by metabolic (45 %) and CNS disease (39 %). Patients required ICU management by 60 %, with a mortality of 27 % in the whole cohort. The most frequent EEG finding was generalized continuous slow-wave activity (66 %). Epileptic activity was observed in 19 % including non-convulsive status epilepticus, seizures and interictal epileptiform discharges. Periodic patterns were observed in 3 patients (3.2 %). Multivariate analysis found that cancer comorbidity and requiring an EEG during the third week of evolution portended a higher risk of mortality ConclusionWe observed that the most prevalent EEG finding in this cohort was generalized continuous slow-wave activity, while epileptic activity was observed in less than 20 % of the cases. Mortality risk factors were comorbidity with cancer and requiring an EEG during the third week of evolution, possibly related to the hyperinflammatory state.

Charlson comorbidity index scores and in-hospital prognosis of patients with severe acute respiratory infections.

Respiratory infections are one of the leading causes of mortality, and comorbid conditions play a significant role in the severity and fatality of these infections. We evaluated the Charlson Comorbidity Index (CCI) score and possible predictors of mortality in hospitalised patients with severe acute respiratory infection (SARI), aiming to test if the CCI is a valid in-hospital prognostic indicator. Patients older than 14 years, hospitalised from 2010 to 2016 due to SARI by viral infection and who were submitted to respiratory virus testing were included. We assessed comorbidity retrospectively through chart review and calculated four variants of the CCI. Of the 291 patients assessed, 72.8% (n = 212) presented comorbidities, and 24% died (n = 70). The most recurrent comorbidities were chronic pulmonary disease (n = 76/212, 36%) and HIV (n = 50/212, 23.6%). The 1994 age-adjusted CCI predicted in-hospital mortality in SARI patients (P = 0.04), and HIV was associated with in-hospital mortality (P = 0.032). The comorbidity scores used to assess mortality risk in hospitalised patients with SARI displayed poor results, but HIV infection was considered a marker of severity. However, other factors should be considered in order to compose a score system that allows us to specifically assess the risk of mortality in patients with SARI.

Predictors of Survival in Patients Over 80 Years Old Treated with Fenestrated and Branched Endograft

Fenestrated and branched endovascular aneurysm repair endograft (f/bEVAR) allows the endovascular repair of thoracoabdominal and juxtarenal and pararenal abdominal aortic aneurysms (T-J-P-AAAs); however, given their high cost and complexity, their use should be limited to patients with life expectancy >2years. Nevertheless, the number of patients older than 80years treated by f/bEVAR is growing, with no hard evidence of the real efficacy in this context. The aim of the present study is to analyze the survival of ≥80-year-old patients treated with f/bEVAR, and to identify possible predictors of late mortality. An analysis of clinical, anatomical, and technical characteristics of patients treated with f/bEVAR for J-, P-, and T-AAA from 2010 to 2019 in a single academic center was performed. Follow-up data were collected prospectively with clinical visit and computed tomography angiography at discharge, after 6 months, and yearly thereafter. Survival after 2years was evaluated by Kaplan-Meier analysis. Possible predictors of mortality were evaluated by univariable/multivariable analysis. In the study period, a total of 243 f/bEVARs were considered: 83 for TAAA (34%) and 160 for J/PAAA (66%). Mean age was 73±6years, with 35 (14%) patients ≥80 years old; 209 patients (86%) were male and 78 (39%) had an American Society of Anesthesiology score IV. The 30-day and 2-year survival were 96% and 80±3%, respectively. At a mean follow-up of 36±25months, independent predictors of late mortality by Cox regression analysis were chronic obstructive pulmonary disease (COPD), chronic renal failure (CRF), and ≥80 years old (hazard ratio [HR] 1.8, 95% confidence interval [CI] 1.02-3.2, P=0.05; HR 1.7, 95% CI 1.01-3.4, P=0.04; HR 3.1, 95% CI 1.5-6.3, P=0.002, respectively). Preoperative clinical characteristics were similar in ≥80 years old versus younger patients, except for the prevalence of TAAA (14% vs. 38%, P=0.04). The technical success and 30-day mortality were similar in ≥80 vs. <80-year-old patients (93% vs. 96%, P=0.31; 7% vs. 3.5%, P=0.60, respectively). The 2-year survival estimation was significantly lower in ≥80 years old compared with younger patients (62±10% vs. 82±3%, P=0.003). The association of COPD and CRF significantly affects the 2-year survival in ≥80-year-old patients (no patients survived at 2years) and was significantly different compared with the survival in ≥80-year-old patients without these risk factors (70±11%, P=0.001). The early mortality rate and the 2-year survival after f/bEVAR justify this type of treatment in patients ≥80 years old; however, the presence of comorbidities such as COPD and CRF significantly reduces mid-term survival in this group and should be taken into consideration in the indication to f/bEVAR.

Has the profile of native infective endocarditis changed over the years?

Despite recent advances in diagnosis and treatment, Infective endocarditis remains a serious disease with high morbidity and mortality. Its profile has evolved continuously in developed countries; however in developing countries,only few data have been available during the last years Although several studies have evaluated possible predictors of mortality in patients with IE, recent reports from Tunisia are scarce. The aim of this study is to outline recent changes in the profile of native infective endocarditis (NIE) in a tertiary care hospital in Tunisia over the last10 years and to determine predictors of outcome. We gathered retrospectively the data of 110 patients who fulfilled the modified Duke's criteria for native IE between the period 2007–2017. The logistic regression model was used to identify predictive factors for death. The mean age of patients was 39.2 ± 14 years, a male predominance was noted. Rheumatic heart disease was the predominant underlying heart condition (92%). The infective agent was identified in 40. 9% of cases, the most frequent causative agents were streptococci (46.6%), followed by staphylococci (42.2%). Echocardiography showed vegetations in 90% of cases, abscesses in (12.7%) and valvular mutilation in 21%. Complication was dominated by heart failure in 36% of patients. Surgery was performed during the acute phase of the IE in 29% of cases. The overall in-hospital mortality was 21.8%. On multivariate analysis, staphylococci infection, heart failure, neurological complications and abscesses were predictors of inhospital mortality, NIE remains a severe disease affecting the young population in Tunisia, rheumatic heart disease continues to be the most common underlying heart condition, and streptococci were the major causative agents, its prognosis is still dark with high rate of mortality.

Sarcopenia and Type 2 diabetes mellitus as predictors of 2-year mortality after hospital discharge in a cohort of hospitalized older adults

IntroductionSarcopenia has been discussed as a possible predictor of mortality in the older people, but there are few studies evaluating the relationship between mortality and sarcopenia in the population of patients with type 2 diabetes (T2D), especially after hospital discharge. Objective: To evaluate whether coexistence of sarcopenia and T2D predicts mortality after two years of hospital discharge in older patients compared to a control group without diabetes. MethodologyA prospective study that included patients hospitalized between July 2015 and December 2017. To assess sarcopenia, a Timed Up and Go (TUG) test was performed, muscle strength was measured by handgrip, and muscle mass was measured across the largest calf circumference region. This project was approved by the HCPA Ethics Committee under number 150068. Results610 patients were included. The group was stratified according to the presence of diabetes, 306 (51%) patients had TD2. Patients with T2D had lower muscle strength (19.62 ± 7.53 vs. 21.19 ± 7.31p = 0.009), were slower in TUG test (23 vs. 16 s; p < 0.001) than those without T2D, 46.3% being classified as sarcopenic. The mortality rate among T2D was 28%. After adjustment, the coexistence of T2D and sarcopenia was independently associated with mortality after hospital discharge (HR: 1.78; 95% CI: 1.06–2.30). ConclusionOlder patients with T2D and sarcopenia had a higher risk of mortality after hospital discharge compared to a control group.

2209. Charlson Comorbidity Index Scores and In-hospital Prognosis in Severe Acute Respiratory Infections Patients

BackgroundRespiratory infections are one of the leading causes of mortality, and comorbid conditions play a significant role in the severity and fatality of these infections. The Charlson Comorbidity index (CCI) is the most used comorbidity index, presenting a few updated versions since its establishment. In the present study, we evaluated the CCI score and possible predictors of mortality in hospitalized patients with Severe Acute Respiratory Infection (SARI), aiming to test whether the CCI is a valid in-hospital prognostic indicator.MethodsPatients older than 14 years, hospitalized from 2010 to 2016 due to SARI by viral infection, and who were submitted to respiratory virus testing were included. We assessed comorbidity retrospectively through chart review, and calculated 4 variants of the CCI.ResultsOf the 291 patients assessed, 72.8% (n = 212) presented comorbidities and 24% died (n = 70). The most recurrent comorbidities were Chronic Pulmonary Disease (n = 76/212, 36%) and HIV (n = 50/212, 23.6%). Respiratory virus testing was positive in 38.1% of patients (n = 111), Influenza and Rhinoviruses being the most frequent. The 1994 Age-adjusted CCI predicted in-hospital mortality in SARI patients (P = 0.04), and HIV was independently associated with in-hospital mortality (P = 0.032).ConclusionThe comorbidity scores used to assess mortality risk in hospitalized patients with SARI displayed poor results, but HIV infection was considered a marker of severity. However, other factors should be considered in order to compose a scoring system that allows us to specifically assess the risk of mortality in patients with SARI. Disclosures All authors: No reported disclosures.

Predictors of mortality in children with acute kidney injury in intensive care unit

Background Acute kidney injury (AKI) can increase the morbidity and mortality in children admitted to the pediatric intensive care unit (PICU). Previous published studies have mostly been conducted in high-income countries. Evaluations of possible predictors of mortality in children with AKI in low- and middle-income countries have been limited, particularly in Indonesia.&#x0D; Objective To assess possible predictors of mortality in children with AKI in the PICU.&#x0D; Methods We conducted a retrospective cohort study at Dr. Sardjito Hospital, Yogyakarta, Indonesia. All children with AKI admitted to PICU for more than 24 hours from 2010 to 2016 were eligible and consecutively recruited into the study. Logistic regression analysis was used to identify independent predictors.&#x0D; Results Of the 152 children with AKI recruited, 119 died. In order to get a P value of &lt;0.25, multivariate analysis is run to degree AKI, ventilator utilization, primary infection disease, MOF and age.Multivariate analysis showed that ventilator use, severe AKI, and infection were independently associated with mortality in children with AKI, with odds ratios (OR) of 19.2 (95%CI 6.2 to 59.7; P&lt;0.001), 8.6 (95%CI 2.7 to 27.6; P&lt;0.001), and 0.2 (95%CI 0.1 to 0.8; P=0.02), respectively.&#x0D; Conclusion The use of mechanical ventilation and the presence of severe AKI are associated with mortality in children with AKI admitted to the PICU. Interestingly, the presence of infection might be a protective factor from mortality in such patients.

Serum Albumin Trend Is a Predictor of Mortality in ICU Patients With Sepsis.

Patients admitted to the hospital with sepsis are 8 times more likely to die than patients with other diagnoses. There is no diagnostic test that clearly identifies the presence of the dysregulated host response that is central to sepsis. Researchers have identified serum albumin as a possible predictor of mortality in a number of critically ill patient populations. However, these studies primarily focus on the levels on admission, neglecting the clinically significant decrease that occurs subsequently. The purpose of this study was to examine the relationship between the trend of serum albumin over time and mortality in adults admitted to the intensive care unit (ICU) with sepsis. This retrospective, correlational study used existing medical record data. All patients admitted to the ICU at a Midwestern regional medical center with a primary sepsis diagnosis were included in the initial sample. Logistic regression analysis was used to assess the ability of serum albumin to predict mortality. Serum albumin trend, admission serum albumin level, and lowest serum albumin level were significant unique predictors of mortality. The probability of survival decreases by 70.6% when there is a strong negative trend in serum albumin level, by 63.4% when admission serum albumin is ≤2.45 g/dl, and by 76.4% when the lowest serum albumin is ≤1.45 g/dl. Clinicians are encouraged to measure serum albumin levels in patients with sepsis. Low serum albumin levels and a strong negative trend in serial measurements should instigate aggressive monitoring and treatment in this population.

Predictors of Mortality in Living Donor Liver Transplantation

BackgroundEgypt has the highest prevalence of the world hepatitis C virus (HCV) load. Hence, the problem of end-stage liver disease (ESLD) is considered a huge burden on the community. Living donor liver transplantation (LDLT) is the only source of donation in Egypt till now. Survival rates had shown significant improvement in the past decades. This study provides analysis of the mortality rates and possible predictors of mortality following LDLT. It also aids in developing a practical and easy-to-apply risk index for prediction of early mortality. Patients and MethodsThis study is a retrospective study that was designed to analyze data from 128 adult patients with ESLD who underwent LDLT in the Liver Transplantation Unit at Faculty of Medicine, Cairo University. Early and late mortality were identified. All potential risk factors were tested using univariate regression for association with early and late mortality. Significant variables were then entered into a multivariable logistic regression model for identifying the predictors for mortality. ResultsSepsis was the most common cause of early mortality. Early mortality and 1-year mortality were 29 (23%) and 23 (18%), respectively. Model for End-Stage Liver Disease (MELD) score, intraoperative packed red blood corpuscles (RBCs), and duration of intensive care unit (ICU) stay were found to be independently associated with early mortality. ConclusionA MELD score >20, intraoperative transfusion >8 units of packed RBCs, and ICU stay >9 days are three independent predictors of early mortality. Their incorporation into a combined Risk Index can be used to improve outcomes of LDLT.