The overarching prognostic role of tumor progression prior to cytoreductive hepatectomy in NETLM.

BACKGROUNDSpontaneous intracerebral hemorrhage (ICH) is a severe form of stroke with high early mortality, and hematoma enlargement (HE) occurs in roughly one-third of patients and strongly predicts poor outcomes. Quantitative image analysis using handcrafted radiomics and deep learning-derived features can capture hematoma and perihematomal edema (PHE) heterogeneity objectively that the combination of these approaches with clinical data may improve early prediction of HE and in-hospital mortality.AIMTo evaluate and validate the predictive performance of hematoma- and PHE-derived features on non-contrast computed tomography via handcrafted radiomics and automatic deep learning analysis for prediction of early HE and hospital mortality in spontaneous ICH.METHODSOf 322 patients with basal ganglia ICHs were included retrospectively between June 2018 and June 2020, and assigned into the training cohort (n = 225) and the testing cohort (n = 97). We extracted features on hematoma and PHE subregions via handcrafted radiomics analysis manually and deep learning analysis of pretrained convolutional neural networks via transfer learning automatically. Support vector machine was adopted as the classifier for prediction of HE and hospital mortality. The clinical-radiological integrated models for HE and hospital mortality were constructed on clinical data and radiological signatures generated from the radiological models with the optimal area under the receiver operating characteristics curve in the testing cohort.RESULTSThe clinical-radiological model combining clinical information and hematoma- and PHE-derived computed tomography features for prediction of HE implied an area under the receiver operating characteristics curve of 0.828 with 95% confidence interval of 0.714 to 0.942 with accuracy of 72.89%, sensitivity of 70.00%, and specificity of 74.52% in the testing cohort. The model integrating clinical and radiological features showed great identification performance for predicting hospital mortality, demonstrating significant classification and discrimination abilities after validation.CONCLUSIONQuantitative radiomics features from hematoma and PHE regions on non-contrast computed tomography images showed good performance for predicting HE and hospital mortality in patients with ICH.

Our study sought to determine the usefulness of biomarkers of systemic inflammation (C-reactive protein (CRP), procalcitonin (PCT) and proadrenomedullin (proADM)) on hospital admission, as compared to the CURB65 score, for predicting 30- and 90-day mortality in patients hospitalized for community acquired pneumonia (CAP). Observational, prospective study of adults admitted for CAP in four Spanish teaching hospitals. Disease severity was determined within the first 24 h of diagnosis, using the CURB65 score. CRP, PCT and proADM levels were assessed from samples obtained in the Emergency Department (ED). We compared the capacity of the different biomarkers and the CURB65 score to predict pneumonia-related 30- and 90-day mortality. A total of 956 patients hospitalized with CAP were included, 462 in the internal and 494 in the external sample. Of the biomarkers, proADM showed the greatest AUC for predicting 30- and 90-day mortality (0.80 and 0.76 respectively). Mortality at 30 and 90days increased as proADM levels rose. When proADM was used as a continuous variable, CURB65 showed a similar predictive capacity (AUC 0.80) to both crude and age-adjusted proADM (AUC 0.80 and 0.83 respectively) for 30-day mortality. The same was also true for 90-day mortality. However, proADM used as a categorical variable had a greater predictive capacity for 90-day mortality than the CURB65 score (<0.001). Amongst patients admitted for CAP, the use of proADM obtained in the ED may be useful for identifying patients at greatest risk of mortality, with a similar predictive capacity to the CURB65score.

Real-world Predictors of Early Mortality and Treatment Discontinuation in HCC Patients Treated with Atezolizumab-Bevacizumab.

Transcatheter aortic valve implantation (TAVI) has revolutionized the treatment of severe aortic stenosis; however, early mortality risk stratification remains challenging. The Naples Prognostic Score (NPS), which integrates inflammatory and nutritional markers, has shown promise in cardiovascular disease prognosis. This study investigated the relationship between preprocedural NPS and 30-day mortality in patients undergoing TAVI. This retrospective, single-center study analyzed 308 patients aged ≥ 65 years who underwent elective transfemoral TAVI between August 2012 and December 2022. NPS was calculated using the neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, serum albumin, and total cholesterol levels. Patients were stratified into low NPS (0-2) and high NPS (3-4) groups. The primary endpoint was 30-day all-cause mortality. The mean age was 79.81 +- 7.68 years, and 54.9% patients were female. The high NPS group comprised 191 patients (62.0%), while 117 patients (38.0%) were in the low NPS group. Thirty-day mortality was significantly higher in patients with high NPS (16.8% vs. 4.3%, P < 0.001), representing nearly a four-fold increased risk. NPS demonstrated good discriminative ability for mortality prediction (area under the curve: 0.692, 95% confidence interval: 0.611-0.774, P < 0.001), performing comparably to established surgical risk scores. Independent predictors of mortality included age (odds ratio [OR] 1.067, P = 0.039), neutrophil-to-lymphocyte ratio (OR 1.062, P = 0.048), and pulmonary artery pressure (OR 1.039, P = 0.006). The Naples Prognostic Score is a significant predictor of early mortality following TAVI and offers a simple, readily available tool for preoperative risk stratification. Patients with high NPS may benefit from enhanced perioperative monitoring and targeted interventions.

Although the establishment and growth of trauma systems indicate a move toward a bimodal distribution with a decrease in late deaths, research reveal that deaths within minutes or a few hours after injury remain mostly unaltered. The majority of possibly preventable deaths from trauma occur shortly after injury, with the majority of deaths occurring before hospital admission. This is especially visible in armed conflict or war zones. The purpose of this study was to investigate the incidence and determinants of early mortality among trauma patients who visited emergency departments of referral hospitals in west Amhara, Ethiopia, in 2024. This study conducted an institution-based prospective observational study of 531 trauma patients utilizing a consecutive sampling strategy with an interviewer-administered questionnaire and a structured checklist online using Kobo Collect. The data were exported to Stata 17 for analysis. Descriptive statistics including frequencies, proportions, and medians were computed. The median time was estimated using the Kaplan-Meier curve, and survival differences were compared using the Log-rank test across different categories of explanatory variables. Cox proportional hazards models were employed to investigate the statistical association. The proportional hazard assumptions were statistically and graphically verified using the global test and log-log plots, respectively. The degree of relationship was reported using the hazard ratio and 95% confidence intervals (CIs). The variables with a p-value < 0.25 in the bivariable analysis were included in the multivariable analysis model. Statistical significance was determined using a p-value of less than 0.05. Completed study data were available for 518 trauma patients, representing 97.6% of the intended cohort. The average age of study participants was 33.48 ± 14.05, with males accounting for almost 75% of severe injury victims. During this time, 66 (12.74%) people died. The restricted mean survival time (RMST) was found to be 21h (95% CI: 20.2-21.7). The overall incidence rate of early mortality was 15.260 per 1000 person-hours (95% CI = 12.00, 19.42) with a total of 4,325 patient-hour observations. Female sex (AHR = 4.27; 95% CI = 2.03, 9.01), ambulance mode of arrival (AHR = 3.52; 95% CI = 1.90, 6.64). DBP of below 60mmHg (AHR = ;10.50; 95% CI = 5.35, 20.59), DBP above 90mmHg (AHR = 7.38; 95% CI = 1.83, 29.80), GCS score indicating moderate (9-12 ) injury (AHR = 8.17; 95%CI = 3.10, 21.63), and GCS score indicating severe (< 9) injury (AHR = 21.20; 95%CI = 9.65, 46.58) were found to be significantly associated with early mortality. This study found that the incidence of early mortality is notable. It identifies important variables associated with early mortality in the study area, such as female sex, abnormal DBP, and GCS score indicating moderate to severe injury. To reduce early trauma mortality, efforts should focus on early detection and management of physiological instability, prompt neurological assessment, and better coordination between referring and referral hospitals.

Analysis of risk factors for early death of lymphocyte subsets in adult patients with secondary hemophagocytic lymphohistiocytosis.

Background Despite advancements in surgical techniques, coronary artery bypass grafting (CABG) for patients with recent acute myocardial infarction (AMI) remains associated with relatively high mortality. Risk prediction in these patients is essential. The aim of this study was to develop a nomogram model to predict the early postoperative mortality in patients undergoing surgical revascularization for AMI based on preoperative clinical features. Method We retrospectively analyzed the clinical data of 332 consecutive patients who underwent CABG for AMI at our center from January 2018 to December 2024. Independent predictors for early postoperative death were identified by using univariate and multivariate logistic regression models. A nomogram prediction model was developed based on all independent predictors. Discriminative ability, calibration, and clinical utility of the model were evaluated. Internal validation was performed utilizing the bootstrapping method. Results The nomogram model incorporated seven independent predictors: preoperative cardiac arrest, previous history of myocardial infarction(MI), left ventricular ejection fraction (LVEF) <50%, MI-to-CABG interval ≤ 3d, age > 75 years, serum albumin < 35g/L and serum creatinine > 2.0 mg/dL. The model achieved good discrimination with an area under the receiver operating characteristic curve (AUC) of 0.905 (95% CI: 0.832–0.978), and showed well-fitted calibration curves with Hosmer–Lemeshow test results (χ 2 = 3.437, p = 0.944). Decision curve analysis indicated that the model can provide greater clinical net benefits compared to "operate-all" or "operate-none" strategies in a wide range of threshold probability. Conclusions The novel nomogram model combining seven preoperative clinical predictors can provide an accurate preoperative estimation of early postoperative death for AMI patients undergoing surgical revascularization, with satisfactory discrimination and calibration.

BACKGROUNDChronic kidney disease (CKD) contributes significantly to emergency department (ED) presentations in low- and middle-income countries. These patients frequently have multiple comorbidities and face high in-hospital mortality. However, limited data exist on early predictors of mortality at ED admission. Identifying key clinical and laboratory features associated with adverse outcomes may support timely risk stratification and targeted interventions for acutely ill CKD patients.AIMTo identify baseline predictors of in-hospital mortality in adult Indian patients with CKD admitted to the ED.METHODSThis retrospective study was conducted from January 2021 to December 2022 at the Acute Care and Emergency Medicine Unit of the Postgraduate Institute of Medical Education and Research, Chandigarh, India. CKD was diagnosed and staged following the Kidney Disease: Improving Global Outcomes guidelines. Data were extracted from medical records using a structured form. All consecutive patients aged ≥ 18 years were included. Independent mortality predictors were identified using multivariate Cox regression analysis.RESULTSAmong 354 patients (mean age 49 years; 58% males), 60.5% had CKD stage 5, and 41.2% were on maintenance dialysis. Hypertension (74.9%) and diabetes (46.0%) were common comorbidities. Diabetic kidney disease was the primary etiology in 35.6%, while 43.2% had unknown causes. Infection (63.0%) was the most frequent cause for ED admission. In-hospital mortality was 29.1% (n = 103). Independent mortality predictors were Glasgow coma scale (GCS) < 15 [hazard ratio (HR): 1.822, P = 0.017], hyperglycemia (HR: 1.641, P = 0.020), and low albumin (HR: 1.270, P = 0.028). Advanced age, Charlson comorbidity Index, quick Sequential Organ Failure Assessment, and neutrophilia were significant in univariate but not multivariate analysis. CKD stage, dialysis dependency, cardiovascular disease, and neutrophil-lymphocyte ratio were not predictive.CONCLUSIONA low GCS, hyperglycemia, and low albumin levels at admission independently predict in-hospital mortality in CKD patients presenting to the ED, warranting early recognition and targeted interventions.

BackgroundThis study aimed to identify people living with HIV (PLWH) with tuberculosis (TB) co-infection, explore their demographic and clinical characteristics, and determine predictors of early mortality within 6months of TB diagnosis.MethodsA cross-sectional study was conducted in a tertiary referral center in Türkiye of PLWH diagnosed with TB between 2004 and 2023. Demographic, clinical, and laboratory data were reviewed, and statistical analyses were performed to identify early mortality predictors.ResultsAmong 1541 PLWH, 62 (4%) had TB, and 23 (37%) died within 6months. TB presentations were pulmonary (44%), extrapulmonary (27%), and both (29%). Predictors significantly associated with early mortality included lymphopenia (p = 0.009), a CD4 + T lymphocyte count ≤50 cells/mm3 (p = 0.015), anemia (p = 0.009), and thrombocytopenia (p = 0.034), particularly platelet counts below 150,000/mm3 (p = 0.001). Clinical predictors also included symptoms such as fever (p = 0.017), anorexia (p = 0.012), weight loss (p = 0.012), and altered mental status (p = 0.043). Additionally, receiver operating characteristic (ROC) analysis demonstrated that CD4 + T lymphocyte count ≤50 cells/mm3 (AUC = 0.76, p = 0.039) and platelet count <150,000/mm3 (AUC = 0.71, p = 0.034) were significant predictive cutoffs for early mortality. TB culture positivity was high (84%), while PCR positivity was low (15%). Opportunistic infections were seen in 11% of cases.ConclusionsHigh early mortality among people living with HIV/TB co-infection is associated with advanced immunosuppression and hematological abnormalities. These results highlight the importance of early HIV detection and close clinical monitoring to reduce mortality.

BackgroundEarly in-hospital mortality remains an important concern after coronary artery bypass grafting. Existing risk scores, such as EuroSCORE and STS, rely mainly on demographic and clinical parameters and do not adequately incorporate routine hematological markers. This study aimed to develop and validate the Hematological Inflammatory Gradient Score (HIGS), a novel model derived from routinely available hematological indices, to predict early postoperative mortality after coronary artery bypass grafting (CABG).MethodsA retrospective, single-center cohort of 202 patients undergoing elective isolated CABG between January 2022 and March 2024 was analyzed. HIGS was calculated using standardized z-scores of red cell distribution width (RDW), platelet distribution width (PDW), and immature granulocyte percentage (IG%). Discrimination was assessed with ROC curve analysis, while logistic regression identified independent predictors of mortality.ResultsIn-hospital mortality occurred in 10.9% (22/202) of patients. Compared with survivors, non-survivors had significantly higher HIGS values (1.02 ± 0.74 vs –0.12 ± 0.43, p < 0.001). HIGS demonstrated the highest discriminative ability for mortality prediction among tested parameters (AUC = 0.862, 95% CI: 0.794–0.931), with 86.4% sensitivity and 78.9% specificity at the optimal cut-off (>0.44). When added to the base model consisting of age, ejection fraction, and urea, HIGS provided a modest improvement in discrimination (AUC increase from 0.639 to 0.665). In multivariate analysis, lower ejection fraction, higher IG%, and elevated urea were independent predictors of mortality, and inclusion of HIGS improved model performance.ConclusionHIGS is a simple, inexpensive, and biologically plausible score derived from routine blood tests that reliably stratifies early mortality risk after CABG. If confirmed in larger, prospective multicenter studies, HIGS may serve as a practical adjunct to conventional risk models in perioperative decision-making. Given the retrospective, single-center design and limited event count, these findings should be interpreted cautiously, and external validation is required.

Introduction: Pulmonary embolism (PE) is a life-threatening condition with variable clinical presentation and prognosis. Early identification of patients at increased risk of mortality remains a challenge, especially in intermediate-risk categories. Red blood cell distribution width (RDW), a routinely measured hematologic parameter, has emerged as a potential prognostic marker in various cardiovascular conditions. Aim: To evaluate the predictive value of RDW for early (30-day) mortality in patients with acute PE. Material and methods: This retrospective study included 58 consecutive patients with CTPA-confirmed acute PE treated at a tertiary cardiac center between 2023 and 2024. Patients were stratified into early mortality risk groups according to the 2019 ESC guidelines. RDW and other hematologic and biochemical parameters were recorded on admission. Correlation, logistic regression, and receiver operating characteristic (ROC) analyses were used to assess associations with 30-day mortality. Results: Seven patients (12.1%) died within 30 days. RDW values were significantly higher among non-survivors with a moderate positive correlation with mortality (r=0.363, p=0,005). ROC analysis revealed an AUC of 0.771 for RDW in predicting early mortality, with an optimal cut-off of ≥14.05% (sensitivity 83.3%, specificity 59.6%). In logistic regression, RDW was an independent predictor of 30-day mortality (OR 1.637, 95% CI: 1.058-2.535; p= 0.027). Traditional clinical scores such as PESI and sPESI were not significantly associated with mortality. Conclusion: RDW is an independent, easily obtainable predictor of early mortality in acute PE and may enhance risk stratification, particularly in intermediate-risk patients. Its integration into clinical assessment could improve early decision-making and patient management.

Major bleeding and recurrent venous thromboembolism (VTE) both lead to a poor prognosis among patients with VTE. Low body weight (BW) may be a risk factor for bleeding; however, data on its impact remain limited in the direct oral anticoagulant (DOAC) era.We investigated the relationship between low BW and long-term outcomes among VTE patients in the DOAC era.From the COMMAND VTE Registry-2 in Japan between January 2015 and August 2020, we analyzed 4,959 patients with symptomatic VTE, who were divided into low BW (≤60 kg) (N = 2,897) and non-low BW (>60 kg) (N = 2,062) groups. The primary outcome was major bleeding.The low BW group was older (71.3 vs. 62.5 years, P < 0.001), included a higher percentage of female (75% vs. 36%, P < 0.001), and received initial intensive DOAC therapy less often (64% vs. 75%, P < 0.001) and reduced maintenance DOAC doses more frequently (51% vs. 15%, P < 0.001) than the non-low BW group. The risks of major bleeding (16.7% vs. 10.8% at 5 years; adjusted HR 1.43, 95%CI 1.15-1.77, P = 0.001) and all-cause death (38.9% vs. 23.2%; HR 1.59, 95%CI 1.39-1.81, P < 0.001) were higher in the low BW group than in the non-low BW group, while the risk of recurrent VTE was similar (9.4% vs. 9.7%; HR 0.98, 95%CI 0.75-1.29, P = 0.90).Low BW correlated with higher risks of major bleeding and all-cause death, but not recurrent VTE in the DOAC era.

Risk factors for mortality in patients following total hip arthroplasty and hemiarthroplasty due to femoral neck fractures.

Acute kidney injury (AKI) is prevalent in Intensive Care Unit settings, with rates exceeding 50%. While many studies from sub-Saharan Africa focus on critically ill AKI patients, limited data exist on non-critically ill patients, hindering effective dialysis prioritization. Studies from developed countries suggest AKI is also common in non-critical settings. This study aimed to assess mortality rates among critically ill and non-critically ill hospitalized AKI patients and identify early mortality predictors at the time of AKI diagnosis. A single-center prospective cohort study was conducted at Kilimanjaro Christian Medical Center between September 2023 and February 2024. Patients admitted to the internal medicine ward were assessed, with critical illness determined using the Universal Vital Assessment (UVA) score. Cox regression identified predictors of in-hospital mortality, and Kaplan-Meier curves assessed survival time. Out of 1,211 admissions, 139 patients met inclusion criteria. Overall hospital mortality was 39.6%, higher in critically ill patients (57.1% vs. 21.7%, p < 0.001). Predictors of mortality included critical illness (aHR 3.44, p < 0.001), traditional herbal medicine (THM) intoxication (aHR 5.99, p = 0.002), volume depletion (aHR 1.95, p = 0.028), referral from regional hospitals (aHR 2.78, p = 0.002), and age >60 (aHR 2.46, p = 0.001). Critically ill patients had shorter median survival (12 vs. 20 days; p = 0.001), which declined with higher UVA risk. While critical illness predicts AKI in-hospital mortality, non-critical AKI patients—often affected by THM, volume depletion, or regional hospital referrals are also at risk. Older age (>60 years) is a non-modifiable predictor of in-hospital mortality in AKI.

Author's reply to "Preoperative prediction of early mortality after surgery for spinal metastases".

Letter to "Preoperative prediction of early mortality after surgery for spinal metastases".

This study aimed to determine the frequency, causes, mortality rates, and predictors of mortality in patients with extreme hyperferritinemia (≥ 5000ng/mL) followed in rheumatology and hematology clinics. Patients with a ferritin level of ≥ 5000ng/mL were retrospectively screened using the electronic data recording system. Extreme hyperferritinemia was detected in 0.76% of 43,110 ferritin tests performed over 13years. The data of 139 patients, including 35 patients from the rheumatology clinic and 104 patients from the hematology clinic, were analyzed. In the study, 71.4% of rheumatology cases and 50.9% of hematology cases were female. The median ferritin value for the overall group was 7768ng/mL, and the mean value was 13,022 ± 17,141 (5017-100,000) ng/mL. Regarding the etiology of extreme hyperferritinemia, iron overload was detected in 42.4% of all patients, infection in 23.0%, and Still's disease in 14.4%. The most common cause was Still's disease (54.3%) in rheumatology patients and iron overload (55.8%) in hematology patients. Within the first month, 25 (18.0%) patients died. The most common cause of mortality was macrophage activation syndrome (MAS) in rheumatology patients and infection in the hematology group. In rheumatology patients, the risk factors for mortality in univariate analysis were the presence of MAS [HR = 13.257 (95% CI = 1.374-127.934, p = 0.025)]. Ferritin level can predict first month mortality in rheumatology patients with extreme hyperferritinemia (cutoff > 36,137.5ng/mL; sensitivity 100%, specificity 96.77%, p < 0.0001, AUC = 0.976, 95% CI = 0.915-1.000) but not in hematology patients. In conclusion, severe hyperferritinemia may be encountered in rheumatology and hematology practice. Ferritin level may be a good marker for predicting mortality, especially in rheumatology patients. Key points • In patients with extreme hyperferritinemia, the most common etiologies were Still's disease among rheumatology patients and iron overload among hematology patients. •The 1-month mortality rate was 11.4% in the rheumatology group and 20.2% in the hematology group. The leading cause of death was macrophage activation syndrome (MAS) in the rheumatology cohort and infection in the hematology cohort. •Among rheumatology patients, serum ferritin levels were a strong predictor of 1-month mortality, with a cutoff value of >36,137.5 ng/mL yielding a sensitivity of 100%, specificity of 96.77%, and an AUC of 0.976 (95% CI,: 0.915-1.000;, p < 0.0001). However, ferritin levels did not demonstrate predictive value for 1-month mortality in hematology patients.

The rapid expansion of antiretroviral therapy (ART) in Ethiopia has significantly reduced AIDS-related deaths; however, survival rates among people living with HIV (PLHIV) on ART remain variable, and findings on predictors of early mortality are inconsistent. This study aimed to identify factors associated with early mortality among ART users in the Woliso district of Ethiopia. A historical cohort study was conducted among 720 randomly selected ART users from January 2018 to December 2022. Data were collected using Open Data Kit (ODK) and analyzed with STATA 13. Kaplan–Meier survival analysis and Cox proportional hazards regression were employed to assess predictors of mortality. The mortality incidence density was 5.1 per 100 person-years (95% CI: 4.01–6.50). Significant predictors of early mortality included being divorced (AHR: 6.34; 95% CI: 2.05–19.65), advanced WHO clinical stage III/IV (AHR: 2.92; 95% CI: 1.12–8.27), and suboptimal ART adherence—fair (AHR: 5.48; 95% CI: 2.37–12.66) and poor (AHR: 3.50; 95% CI: 1.72–7.09). This study highlights a high early mortality rate, emphasizing the need for early HIV care enrollment and strict treatment adherence to improve survival. Strengthening ART programs with targeted interventions for high-risk groups, such as divorced individuals and those with advanced disease, could further reduce mortality in Ethiopia.

Background: We analyzed patients with acute type-A aortic dissection (ATAAD) presenting with cardiopulmonary arrest (CPA) to establish whether the timing of operative treatment and aggressive cardiopulmonary resuscitation (CPR) are factors in determining outcomes. Methods: A total of 671 patients with ATAAD were brought to our hospital between August 2003 and July 2023. Of the total, 201 patients (30%) presented with CPA. Their mean age was 71.0 ± 13.8 years, with the prevalence of out-of-hospital CPA at 89%. The return of spontaneous circulation (ROSC) was achieved after initial CPR in 25 patients (12%), and extracorporeal cardiopulmonary resuscitation (ECPR) was subsequently applied in 37 patients (18%). Immediate aortic repair was selected as the first line of treatment if ROSC had been achieved during CPR; eventually 30 patients (15%) underwent surgery (CPA patient )(Image 1). Among the patients who had not experienced CPA (non-CPA patient), 439 underwent aortic repair. We analyzed the effects of downtime, defined as the interval between the collapse and return of spontaneous circulation, or between collapse and the establishment of ECPR, as well as immediate aortic repair on surgical outcomes. Results: We observed a significant difference in early mortality rates between patients with CPA and non-CPA of 36.6% (n=11/30) and 5.0% (n=22/439), respectively (P &lt; .001). Among CPA patients, preoperative coronary malperfusion was the only predictor of early mortality (P = .04). Seven CPA patients (23.3%) were able to return home, and the cumulative five-year survival rate was 27.5%. According to the multivariable Cox survival analysis, coronary malperfusion and downtime were associated with increased long-term mortality (P = .002 and P = .009). The optimum downtime cut-off point for predicting discharge from hospital was 18 minutes (P &lt; .001)(Image 2). Conclusions: Although preoperative cardiopulmonary arrest is associated with significantly high mortality in patients undergoing aortic repair for AYAAD, shorter intervals between the collapse and return of circulation, combined with immediate aortic repair, significantly improved their outcomes.