Predictive Factors Of Mortality Research Articles

Serum soluble DR5 predicts mortality risk in patients with HBV-related hepatocellular carcinoma.

Death receptor 5 (DR5) is significantly upregulated in various human tumor tissues; however, the relationship between serum levels of soluble DR5 (sDR5) and the mortality risk of hepatocellular carcinoma (HCC) is not understood. Our aim is to investigate the prognostic value of serum sDR5 in HCC patients. A total of 170 patients with HBV-HCC were recruited, with 82 and 88 patients as derivation and validation cohorts, respectively. sDR5 levels were analyzed using ELISA. The predictive factors for mortality were selected using LASSO regression analysis. Cox regression analysis was used to analyze the independent factors affecting mortality in 2 years. A nomogram based on the interquartile range of the sDR5 values predicted mortality rates. Serum sDR5 level was identified as an independent risk factor for mortality in patients with HBV-HCC. The 2-year cumulative mortality rates of HBV-HCC were 10, 28.57, 38.10, and 95% across the sDR5 quartiles, respectively (p < 0.001). The sDR5 had an AUROC of 0.851 (95% CI: 0.755-0.920) in the derivation cohort. When the cut-off value was 30.06pg/mL, the AUROC of sDR5 was 0.778 (95% CI 0.677-0.860) in the validation cohort. The calibration curves fit well, and the decision curves showed that sDR5 had a high standardized net benefit. sDR5 predicted the prognosis of HBV-HCC patients most accurately. Further, serum sDR5 level was significantly positively associated with BCLC stage and the presence or absence of ascites. sDR5 showed high predictive accuracy in patients with HBV-HCC; thus, it is considered a new serological biomarker.

Predictive Factors for Mortality in Pre-Term Neonates with Necrotizing Enterocolitis: A Retrospective Cohort Study.

Background: Necrotizing enterocolitis (NEC) is a serious neonatal condition. Over the last three decades, there has been progress in neonatal intensive care with an increase in the incidence of pre-term births. This has led to an increase in the incidence of NEC. However, research studies regarding NEC outcomes in low-income countries are scarce. Our study aimed to assess predictive factors for mortality in patients with NEC in a single center in Tunisia. Patients and Methods: We conducted a retrospective data collection through a review of the patients' medical records. All neonates with a medical or surgical management of NEC between January 1, 2010 and March 31, 2022 were included. Results: A total of 102 neonates were included with the overall survival of 47%. Outcomes of the univariable analysis showed that patients in the deceased group had lower gestational age, lower five-minute Apgar score, lower birth weight, and lower platelet count than those in the survivor group. Multivariable logistic analyses demonstrated that gestational age <32 weeks (p = 0.024; odds ratio [OR], 2.5), five-minute Apgar score <8 (p = 0.017; OR, 3.621), birth weight <1,500 g (p = 0.001; OR, 4.136), platelet count <50,000/mm3 (p = 0.029; OR, 2.5), Bell's stage 3 (p = 0.035; OR, 2.496), and sepsis during hospitalization (p < 0.001; OR, 5.971) were associated with mortality in neonates with NEC. Conclusions: Our study showed that gestational age <32 weeks, five-minute Apgar score <8, very low birth weight, severe thrombocytopenia, Bell's stage 3, and sepsis during hospitalization were predictive factors for mortality in neonates with NEC. These factors would be useful to refine treatment modalities for better disease outcomes.

The clinical characteristics and the risk factors for mortality in Non-COVID-19 critical patients in a pandemic hospital in Turkey: a retrospective cross-sectional study.

Coronavirus disease 2019 (COVID-19) disrupted standard health policies and routine medical care, and thus, the management and treatment pathways of many clinical conditions have changed as never before. The negative impact of the pandemic rendered the systemic disease more complicated and accelerated mortality. For the last two years, clinicians have primarily focused on COVID-19 patients; however, the non-COVID-19 critically ill patients needed to be addressed from multiple perspectives. This study investigated the demographic and clinical characteristics of non-COVID-19 critical care patients admitted concurrently with a COVID-19 wave. The objective of this study was to identify the risk factors for mortality in critically ill non-COVID-19 patients. All consecutive cases admitted to the intensive care unit (ICU) were included in the study between January 1, 2021 and July 14, 2021. All data, including age, gender, admission characteristics, patient dependency, pre-existing systemic diseases, the severity of illness (Acute Physiology and Chronic Health Evaluation -APACHE-II), predicted death rate in ICU, life-sustaining medical procedures on admission or during ICU stay, length of stay, and admission time to the ICU, were obtained from the hospital's electronic database. The Charlson Comorbidity Index (CCI) was assessed for all patients. A total of 192 patients were screened during the study period. Mortality was significantly increased in non-surgical patients, previously dependent patients, patients requiring mechanical ventilation, continuous renal replacement therapy, and patients requiring the infusion of vasoactive medications. The number of pre-existing diseases and the admission time had no impact on mortality. The mean CCI was significantly higher in non-survivors but was not a strong predictor of mortality as APACHE II. In this retrospective study, the severity of illness and the need for vasoactive agent infusion were significantly higher in non-survivors confirmed by multivariate analysis as predictive factors for mortality in critical non-COVID-19 patients.

Implications of Cellular Immaturity in Necrosis and Microvascularization in Glioblastomas IDH-Wild-Type.

Necrosis and increased microvascular density in glioblastoma IDH-wild-type are the consequence of both hypoxia and cellular immaturity. Our study aimed to identify the main clinical-imaging and morphogenetic risk factors associated with tumor necrosis and microvascular in the prognosis of patient survival. We performed a retrospective study (10 years) in which we identified 39 cases. We used IDH1, Ki-67 and Nestin immunomarkers, as well as CDKN2A by FISH. The data were analyzed using SPSS Statistics. The clinical characterization identified only age over 50 years as a risk factor (HR = 3.127). The presence of the tumor residue, as well as the absence of any therapeutic element from the trimodal treatment, were predictive factors of mortality (HR = 1.024, respectively HR = 7.460). Cellular immaturity quantified by Nestin was associated with reduced overall survival (p = 0.007). Increased microvascular density was associated with an increased proliferative index (p = 0.009) as well as alterations of the CDKN2A gene (p &lt; 0.001). CDKN2A deletions and cellular immaturity were associated with an increased percentage of necrosis (p &lt; 0.001, respectively, p = 0.017). The main risk factors involved in the unfavorable prognosis are moderate and increased Nestin immunointensity, as well as the association of increased microvascular density with age over 50 years. Necrosis was not a risk factor.

Albumin-Bilirubin Grade as a Novel Predictor of the Development and Short-Term Survival of Post-Banding Ulcer Bleeding Following Endoscopic Variceal Ligation in Cirrhotic Patients.

Background and Objectives: Endoscopic variceal ligation (EVL) is the primary and secondary treatment for acute esophageal variceal bleeding. Post-banding ulcer bleeding (PBUB) may lead to bleeding episodes following EVL, increasing mortality. The aim of this study was to evaluate the risk factors for PBUB and predict the 6-week mortality risk after PBUB. Materials and Methods: We retrospectively analyzed the data collected from cirrhotic patients with EVL from 2015 to 2017. The incidence of PBUB and the 6-week mortality rate were evaluated. Risk factors for PBUB and predictive factors for mortality after PBUB were analyzed. Results: A total of 713 patients were enrolled in this study. Among the studied subjects, the incidence of PBUB was 5.8% (N = 41). The 6-week mortality rate was 63.4% (26/41). In multivariate analysis, MELD score ≥20 (OR: 3.77, 95% CI: 1.94-7.33, p &lt; 0.001), ALBI score of 3 (OR: 2.67, 95% CI: 1.34-5.3, p = 0.005) and the presence of gastric varices (OR: 2.1, 95% CI: 1.06-4.16, p = 0.03) were associated with the development of PBUB. Patients with ALBI grade 3 (OR: 4.8, 95% CI: 1.18-19.6, p = 0.029) and Child-Pugh scores B and C (OR: 16.67, 95% CI: 1.75-158.1, p = 0.014) were associated with 6-week mortality after PBUB. Conclusions: PBUB is a complication with low incidence but increased mortality following EVL. The ALBI grade is a useful score to predict not only the development of PBUB but also the 6-week mortality after PBUB.

Comparison between Cystatin C- and Creatinine-Based Estimated Glomerular Filtration Rate in the Follow-Up of Patients Recovering from a Stage-3 AKI in ICU.

Acute kidney injury (AKI) in critically ill patients is associated with a significant increase in mortality as well as long-term renal dysfunction and chronic kidney disease (CKD). Serum creatinine (SCr), the most widely used biomarker to evaluate kidney function, does not always accurately predict the glomerular filtration rate (GFR), since it is affected by some non-GFR determinants such as muscle mass and recent meat ingestion. Researchers and clinicians have gained interest in cystatin C (CysC), another biomarker of kidney function. The study objective was to compare GFR estimation using SCr and CysC in detecting CKD over a 1-year follow-up after an AKI stage-3 event in the ICU, as well as to analyze the association between eGFR (using SCr and CysC) and mortality after the AKI event. This prospective observational study used the medical records of ICU patients diagnosed with AKI stage 3. SCr and CysC were measured twice during the ICU stay and four times following diagnosis of AKI. The eGFR was calculated using the EKFC equation for SCr and FAS equation for CysC in order to check the prevalence of CKD (defined as eGFR &lt; 60 mL/min/1.73 m2). The study enrolled 101 patients, 36.6% of whom were female, with a median age of 74 years (30-92), and a median length of stay of 14.5 days in intensive care. A significant difference was observed in the estimation of GFR when comparing formulas based on SCrand CysC, resulting in large differences in the prediction of CKD. Three months after the AKI event, eGFRCysC &lt; 25 mL/min/1.73 m2 was a predictive factor of mortality later on; however, this was not the case for eGFRSCr. The incidence of CKD was highly discrepant with eGFRCysC versus eGFRSCr during the follow-up period. CysC detects more CKD events compared to SCr in the follow-up phase and eGFRCysC is a predictor for mortality in follow-up but not eGFRSCr. Determining the proper marker to estimate GFR in the post-ICU period in AKI stage-3 populations needs further study to improve risk stratification.

Standard Risk-Assessment of AML Doesn't Predict the Outcome in Older AML Patients Undergoing Non-Intensive Chemotherapy

Background: Acute myeloid leukemia (AML) still has a poor prognosis for elderly patients, both because of specific characteristics of the disease in this population, and especially because of their frailty that limits the use of intensive treatments (IT). Low dose Aracytine (LDAC) and 5-Azacitidine (5-AZA) are the 2 options currently recommended for these patients, but real-life data are lacking about response rates, survival, and superiority of one treatment over the other. Methods: In our multi-center study based on the French Hauts-de-France AML observatory, we enrolled all patients with newly diagnosed AML treated in first line with LDAC and 5-AZA. The primary endpoint was the overall survival (OS). Our secondary objectives were: evaluating the response rates, identifying predicting factors of early mortality and the profile of long-term survivors (i.e alive 6 months after the diagnosis). Results: Between January 2009 and September 2019, 279 patients who received LDAC (n=87) or 5-AZA (n=192) were included. Median age was 76 years (IQR 70 - 81) (LDAC 79 years (IQR 75 - 83) and 5-AZA 74 years (IQR 68 - 79), p<0.001)) and the Charlson comorbidity index was significantly higher in the LDAC arm: 7 (IQR 6 - 8) versus 6 (IQR 5 - 7) in 5-AZA, p=0.007). Leukocytosis was significantly lower in the 5-AZA group: 3.2G/L (IQR 1.8- 7.7) versus 8.5G/L in LDAC (IQR 2.3-35), p<0.001. Patients treated with 5-AZA predominantly had AMLs associated with myelodysplasia-related changes and adverse cytogenetics according to ELN 2017, whereas those treated with LDAC predominantly had AML NOS with intermediate karyotype. After a median follow-up of 6.9 months (IQR 1.9-11.6), median OS (Figure 1A) was 7.8 months (IQR 2.5 - 13.6): 4.8 months (IQR 2.13 - 14.41) for the LDAC group versus 8.9 months (IQR 3.2 - 13.5) for the 5-AZA group (p=0.046), but there was no significant difference in OS at the end of the study (Figure1B). Complete remission rate was 27.3% without any difference between the 2 groups. At day 30, on the basis of Kaplan-Meier estimates, 25.3% of patients in the LDAC group had died compared to 9.4% in the 5-AZA group (OR 0.28; 95% CI (0.09 - 0.84), p<0.023). After six months of treatment, there was no difference in OS between LDAC and 5-AZA groups (HR 1.37; 95% CI (0.92-2.04), p= 0.116). The predicting factors of mortality at day 30, at 6 months and after 6 months are summarized in the Table 1 (multivariate analysis, odds-ratio). Interestingly, the predictive factors of early mortality were albuminemia less than 30g/L (adjusted OR 6.25; 95% CI (2.08 - 20.00); p<0.001) and treatment with LDAC (adjusted OR 3.57; 95%CI (1.19 - 11.11); p=0.023). At 6 months, ECOG 2-3, high bone marrow blast count at diagnosis and albuminemia less than 30g/L significantly impaired the OS. After 6 months, the only predictive factor of survival was albuminemia greater than 30g/L (adjusted HR 0.65, 95% CI (0.44- 0.96); p=0.030). Usual molecular markers and prognosis classifications (ELN and Lindsley) were not helpful to predict mortality (both early and late) of this specific population. Discussion: Standard prognostic classifications of AML, such as the ELN 2017 and Lindsley classifications, which have been evaluated in patients eligible for IT, do not appear to be accurate in predicting outcome in older unfit patients treated with LDAC or 5-AZA. Albumin, a simple biomarker, was the strongest predictor of early mortality and prolonged survival beyond 6 months, highlighting that nutritional status and global fitness are the key determinants of survival in older patients non eligible for IT. Overall, the low survival emphasizes the poor prognosis of AML in these patients, and the urgent need for innovative therapies. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Predictive Factors of Mortality in Pediatric Patients With AKI Hospitalized in a Tertiary Hospital

Predictive Factors of Mortality in Pediatric Patients With AKI Hospitalized in a Tertiary Hospital

Improving the prognosis before and after liver transplantation: Is muscle a game changer?

Liver transplantation (LT) is currently the only curative treatment option for selected patients with end stage liver disease or hepatocellular carcinoma. Improving waiting list-mortality, post-transplant morbidity and mortality and refining the selection of the patients remain our current central objectives. In this field, different concepts dealing with nutrition and the muscle such as sarcopenia, malnutrition, frailty or myosteatosis have emerged as possible game changers. For more than a decade, many prospective studies have demonstrated that sarcopenia and frailty are major predictive factors of mortality in the waiting list but also after LT. Malnutrition is also a well-known risk factor for morbidity and mor-tality. Muscle composition is a newer concept giving insight on muscle quality which has also been shown to be linked to poorer outcomes. Each of these terms has a precise definition as well as pathophysiological mechanisms. The bi-directional liver-muscle axis makes sense in this situation. Defining the best, easy to use in clinical practice tools to assess muscle quality, quantity, and function in this specific population and developing quality prospective studies to identify interventional strategies that could improve these parameters as well as evaluate the effect on mortality are among the important challenges of today.

Exploration of prognostic factors for prediction of mortality in elderly CAP population using a nomogram model.

BackgroundThe incidence and mortality rate of community-acquired pneumonia (CAP) in elderly patients were higher than the younger population. The assessment tools including CURB-65 and qSOFA have been applied in early detection of high-risk patients with CAP. However, several disadvantages exist to limit the efficiency of these tools for accurate assessment in elderly CAP. Therefore, we aimed to explore a more comprehensive tool to predict mortality in elderly CAP population by establishing a nomogram model.MethodsWe retrospectively analyzed elderly patients with CAP in Minhang Hospital, Fudan University. The least absolute shrinkage and selection operator (LASSO) logistic regression combined with multivariate analyses were used to select independent predictive factors and established nomogram models via R software. Calibration plots, decision curve analysis (DCA) and receiver operating characteristic curve (ROC) were generated to assess predictive performance.ResultsLASSO and multiple logistic regression analyses showed the age, pulse, NLR, albumin, BUN, and D-dimer were independent risk predictors. A nomogram model (NB-DAPA model) was established for predicting mortality of CAP in elderly patients. In both training and validation set, the area under the curve (AUC) of the NB-DAPA model showed superiority than CURB-65 and qSOFA. Meanwhile, DCA revealed that the predictive model had significant net benefits for most threshold probabilities.ConclusionOur established NB-DAPA nomogram model is a simple and accurate tool for predicting in-hospital mortality of CAP, adapted for patients aged 65 years and above. The predictive performance of the NB-DAPA model was better than PSI, CURB-65 and qSOFA.

What is there to EAARN with a CRT implantation? Predictive factors of mortality or clinical deterioration in patients receiving cardiac resynchronization therapy based on pre-implant factors

Abstract Introduction Cardiac resynchronization therapy (CRT) in heart failure patients with reduced ejection fraction (HFrEF) and wide QRS complexes has been shown to improve both functional capacity and quality of life, and to decrease hospital admissions and mortality. Mortality in CRT patients has been associated with several pre-implant risk factors and some risk scores, like the EAARN score, have been developed to try and predict mortality and morbidity in this population. Purpose Our aim was to assess risk factors for a compositive end-point of admissions for heart failure or cardiovascular death at 5 years, particularly the EAARN SCORE (EF, Age, Atrial Fibrillation (AF), Renal dysfunction, New York Heart Association (NYHA) class IV), in patients with EF &amp;lt;35% and QRS &amp;gt;130ms submitted to CRT implantation. Methods We performed a retrospective analysis between 2012 and May of 2019 of all patients admitted for CRT implantation due to HFrEF with EF &amp;lt;35% and QRS &amp;gt;130ms in a single expert centre. Medical records were analysed for clinical, procedural data and outcomes. The predictive accuracy of the score was assessed using the area under curve (AUC) of receiver operating characteristics (ROC) curve. The association between EAARN and the composite end-point at 5-years was analyzed using a Cox regression model. Results Of the 134 patients assessed, 101 patients fulfilled all inclusion criteria. The mean age at implantation was 70.2±10 years with a male preponderance (67.2%). This population was significantly symptomatic, with 35% in NYHA class II, 58% in NYHA class III and 5% in NYHA class IV. Most had an ischemic etiology (74.2%). 75% of patients were considered responders after implantation (NYHA improvement of at least 1 class and/or increase in 10% in EF). A primary composite end-point occurred in 17.8% of patients. The pre-procedure characteristics associated with an event were an ischemic etiology (OR 4.66; CI 95% 1.52–14.24, p&amp;lt;0.05) and pre-procedure EF (OR 0.81; CI 95% 0.81–0.97, p&amp;lt;0.05). The age, sex, NYHA class, presence of AF, renal function, bundle branch block morphology and responder status were non significant. The EAARN Score showed predictive power for the occurrence of an event (OR 1.95; CI 95% 1.13–3.36, p&amp;lt;0.05) and a reasonable discriminative capacity with the ROC curve analysis (figure 1A) demonstrating an AUC of 0.70. The survival analysis (figure 1B) with a Hazard Ratio of 1.88 (CI 95% 1.158–3.058, p&amp;lt;0.05) signifying an increased risk of an event of 88% per EAARN class increase, with the Kaplan Meier curves widening significantly in the different categories of the score. Conclusions In patients who implanted a CRT due to HFrEF with EF &amp;lt;35% and QRS &amp;gt;130ms the EAARN score demonstrated a good predictive power and discriminative capacity for admission for heart failure or cardiovascular death at 5 years although it does not account for the etiology which was also a significant factor. Funding Acknowledgement Type of funding sources: None.

Predictive Factors of Mortality of Stroke in the Neurology Department of Hujr of Befelatanana in Antananarivo

Predictive Factors of Mortality of Stroke in the Neurology Department of Hujr of Befelatanana in Antananarivo

S1397 Hospital Utilization and Survival Analysis in a Model of Outpatient Paracentesis by Interventional Radiology

Introduction: There has been a significant change in outpatient cirrhosis care, as paracentesis is currently performed by interventional radiologists (IR) rather than gastroenterologists/hepatologists or internists. In this model of care, patients’ access could be limited by scheduling availability, and there is no evaluation of their renal function or adjustment of their medications at the time of paracentesis. This study was aimed to analyze hospital utilization and cirrhosis complications within six months of index outpatient paracentesis by IR and to identify potential areas of improvement in care. Methods: This is a retrospective study of patients with cirrhosis and ascites who underwent outpatient paracentesis by IR from October 2015 to October 2018 at a tertiary academic medical center. We collected demographics, data on cirrhosis etiology/complications, laboratory tests, provider notes, outpatient paracenteses dates, emergency department (ED) visits, hospitalizations, and ICU admissions within the following six months post-index paracentesis. Overall survival was analyzed using product-limited survival estimates (Kaplan-Meier). The log-rank test was used to test for differences by cause. Kaplan-Meier survival curves were plotted for overall and stratified survival. Cox regression analyses examined survival by cause while controlling for age and MELD score. Hazard ratios are reported. (Figure) Results: Within 6 months from index paracentesis, 44 patients (64.7%) underwent repeat IR outpatient paracentesis (total 187 paracenteses, 4.25 paracenteses/patient); 42 (61.7%) had ER visits (total 118 ER visits, 2.8/patient), 40 (58.5%) had hospital admissions (total 88 admissions, 2.2/patient) and 11 had ICU admission. On multivariate analysis, the predictive factors for mortality were older age (p=0.04) and MELD score (p=0.082). Baseline MELD was predictive of acute kidney injury (p=0.0184), UGI bleed (p=0.0096), and ICU admission (p=0.0064). The mean overall survival was 35.6 (SD +/- 2.68) months. Mean survival stratified by cause was 36.2 (SD +/- 3.78) months for patients with cirrhosis due to alcohol use, and 41.7 (SD +/- 4.1) months for cirrhosis due to hepatitis B or C. (Table) Conclusion: In this contemporary cohort of patients with cirrhosis undergoing IR outpatient paracentesis, we found a high rate of short-term cirrhosis complications and hospital utilization, while TIPS consideration was very low. Further data is needed to identify specific gaps in care and to analyze long-term survival.Figure 1.: (a) Survival curve using Kaplan-Meier estimator with the cause of cirrhosis as strata. (b) Survival curve for each cause at the average age (60.5) and average MELD score (17.7) Table 1. - demonstrates baseline demographics such as age, gender, and cause of cirrhosis, the most common reasons for readmissions with a 6-month mortality rate, and TIPS status Age n (%) Less than 60 32 (46.37) 60 or more 37 (53.62) Average 60.47 Gender n (%) Male 49 (71.01) Female 20 (28.98) Cause of Cirrhosis n (%) Alcohol 37 (53.62) Hepatitis B and/or C 15 (21.74) Other 17 (24.64) Most common reasons for admissions % Hepatic encephalopathy 39.7% Acute Kidney Injury 38.2% Upper gastrointestinal (UGI) bleed 14.7% Spontaneous bacterial peritonitis (SBP) 14.7% 6-month mortality rate 6.9% TIPS n (%) TIPS performed 4 (0.09) No documentation of TIPS consideration 31 (70.4)

TC-325 hemostatic powder in the management of upper gastrointestinal malignant bleeding: a randomized controlled trial.

Background and study aims Upper gastrointestinal bleeding (UGIB) from malignancy is associated with high rebleeding and mortality rates. Recently, TC-325 powder has shown promising results in the treatment of UGIB, including malignant bleeding. The aim of this study was to compare the efficacy of TC-325 versus best clinical management. Patients and methods From August 2016 to February 2020, all patients with evidence of UGIB from malignancy were randomized to receive TC-325 therapy or control group, in which endoscopic treatment was not mandatory. Exclusion criteria were hemoglobin drop without overt bleeding and UGIB from non-tumor origin. The primary outcome was 30-day mortality. Secondary outcomes were 30-day rebleeding, blood transfusion and length of hospital stay. Results Sixty-two patients were randomized, three were excluded and 59 were included in the final analysis (TC-325 group = 28; control = 31). Groups were similar at baseline. Active bleeding was observed in 22 patients in the TC-325 group and 19 in the control group ( P = 0.15). Successful initial hemostasis with TC-325 was achieved in all cases. Additional therapy (radiotherapy, surgery or arterial embolization) was equally performed in both groups (42.9 % vs 58.1 %; P = 0.243). There were no differences in 30-day mortality (28.6 % vs. 19.4 %, P = 0.406) or 30-day rebleeding rates (32.1 % vs. 19.4 %, P = 0.26). Logistic regression identified no significant predictors of rebleeding. Age, Eastern Cooperative Oncology Group (ECOG) score 3 to 4 and AIMS65 score > 1 predicted greater mortality. Conclusions TC-325 was effective in achieving immediate hemostasis in malignant gastrointestinal bleeding but did not reduce 30-day mortality, 30-day rebleeding, blood transfusion or length of hospital stay. Age, ECOG 3–4, and AIMS65 > 1 were predictive factors of mortality.

Liver transplantation with simultaneous splenectomy increases risk of cancer development and mortality in hepatocellular carcinoma patients.

BACKGROUNDSplenectomy has previously been found to increase the risk of cancer development, including lung, non-melanoma skin cancer, leukemia, lymphoma, Hodgkin’s lymphoma, and ovarian cancer. The risk of cancer development in liver transplantation (LT) with simultaneous splenectomy remains unclear. AIMTo compare hepatocellular carcinoma (HCC) recurrence and de novo malignancy between patients undergoing LT with and without simultaneous splenectomy.METHODSWe retrospectively analyzed the outcomes of 120 patients with HCC within the University of California San Francisco criteria who received LT with (n = 35) and without (n = 85) simultaneous splenectomy in the Tri-Service General Hospital. Univariate and multivariate Cox regression analyses for cancer-free survival and mortality were established. The comparison of the group survival status and group cancer-free status was done by generating Kaplan–Meier survival curves and log-rank tests. RESULTSThe splenectomy group had more hepatitis C virus infection, lower platelet count, higher -fetoprotein level, and longer operating time. Splenectomy and age were both positive independent factors for prediction of cancer development [hazard ratio (HR): 2.560 and 1.057, respectively, P < 0.05]. Splenectomy and hypertension were positive independent factors for prediction of mortality. (HR: 2.791 and 2.813 respectively, P < 0.05). The splenectomy group had a significantly worse cancer-free survival (CFS) and overall survival (OS) curve compared to the non-splenectomy group (5-year CFS rates: 53.4% vs 76.5%, P = 0.003; 5-year OS rate: 68.1 vs 89.3, P = 0.002). CONCLUSIONOur study suggests that simultaneous splenectomy should be avoided as much as possible in HCC patients who have undergone LT.

5-mFI is more accurate than ASA score in predicting postoperative mortality in rectal cancer: A case series of 109 patients

IntroductionThe aim of this study was to compare the accuracy of 5-mFI (modified frailty index) to ASA score (American Society of Anesthesiologists score) in predicting postoperative mortality in patients with rectal cancer. Materials and methodsThe ability of each parameter to predict postoperative mortality was attested in 2 ways: Area under the curve (AUC) was determined using ROC curves analysis. A comparison of AUC was performed using Delong test and Henley-McNeil test.-Multivariate analysis to determine the weight of each variable in predicting postoperative mortality. ResultsThe records of 109 patients undergoing surgical resection, for curative intent, for rectal cancer, were analyzed. Nine patients died during the 30-day postoperative period (8.25%). The optimum cutoff for 5-mFI to predict mortality using the ROC analysis was 1.5. The AUC at the cut-off point was 0.93. The optimum cutoff for ASA score to predict mortality was 1.5 and the AUC at the cut-off point was 0.81. The AUC of 5-mFI was significantly higher than the AUC of ASA score (p < 0.0001 using Delong test and p = 0.0024 using Hanley and McNeil test).On univariate analysis, predictive factors of mortality were: age (p = 0.002), ASA score≥2 (p = 0.0001) and 5-mFI≥2 (p = 0.0001). On multivariate analysis, 5-mFI≥2 was the only factor significantly associated with increased odds of postoperative mortality (OR = 1.73; 95% CI 1.05–2.01). Conclusion5-mFI was more accurate than ASA score in predicting postoperative mortality in patients with rectal cancer.

Machine learning algorithms for predicting mortality after coronary artery bypass grafting.

BackgroundAs the era of big data analytics unfolds, machine learning (ML) might be a promising tool for predicting clinical outcomes. This study aimed to evaluate the predictive ability of ML models for estimating mortality after coronary artery bypass grafting (CABG).Materials and methodsVarious baseline and follow-up features were obtained from the CABG data registry, established in 2005 at Tehran Heart Center. After selecting key variables using the random forest method, prediction models were developed using: Logistic Regression (LR), Support Vector Machine (SVM), Naïve Bayes (NB), K-Nearest Neighbors (KNN), Extreme Gradient Boosting (XGBoost), and Random Forest (RF) algorithms. Area Under the Curve (AUC) and other indices were used to assess the performance.ResultsA total of 16,850 patients with isolated CABG (mean age: 67.34 ± 9.67 years) were included. Among them, 16,620 had one-year follow-up, from which 468 died. Eleven features were chosen to train the models. Total ventilation hours and left ventricular ejection fraction were by far the most predictive factors of mortality. All the models had AUC > 0.7 (acceptable performance) for 1-year mortality. Nonetheless, LR (AUC = 0.811) and XGBoost (AUC = 0.792) outperformed NB (AUC = 0.783), RF (AUC = 0.783), SVM (AUC = 0.738), and KNN (AUC = 0.715). The trend was similar for two-to-five-year mortality, with LR demonstrating the highest predictive ability.ConclusionVarious ML models showed acceptable performance for estimating CABG mortality, with LR illustrating the highest prediction performance. These models can help clinicians make decisions according to the risk of mortality in patients undergoing CABG.

P53. Disparities in recovery and survival rates in cervical versus thoracolumbar spinal deformity patients are attributable to frailty status at presentation

<h3>BACKGROUND CONTEXT</h3> Adult spinal deformity (ASD) and cervical deformity (CD) surgery has seen great improvements in increasing perioperative patient safety and decreasing patient mortality. Previous studies have also demonstrated relatively higher risk of death in cervical deformity surgeries, yet there remains a paucity of literature comparing and contrasting the comorbidities and predictive factors associated with death in ASD versus CD surgery. <h3>PURPOSE</h3> To assess morbidity and mortality rates and potential correlations with frailty in ASD vs CD patients. <h3>STUDY DESIGN/SETTING</h3> Retrospective review of prospective cervical deformity (CD) and adult spinal deformity (ASD) databases. <h3>PATIENT SAMPLE</h3> There were 689 ASD patients, 290 CD patients: 979 total. <h3>OUTCOME MEASURES</h3> Demographic factors; baseline comorbidities; intra/postoperative complications; mortality. <h3>METHODS</h3> Operative CD patients 18yrs with pre-(BL) and up to 5-year (5Y) postoperative radiographic/HRQL data were assessed. Differences in demographics, radiographic alignment, and complication rates were assessed via means comparison analyses. Conditional backstep binary logistic regression analysis identified predictive factors for mortality. Kaplan-Meier curves assessed survivorship of expired patients. Cox regression assessed survivability adjusting for BL frailty status. Logrank analysis determined differences in the survival distribution between ASD and CD patients. <h3>RESULTS</h3> A total of 625 patients met inclusion criteria (417 ASD, 208 CD). Within 5Y, 12 ASD patients (2.88% of ASD cohort) and 16 CD patients (7.69% of CD cohort) expired (p=.004). At baseline, ASD and CD patients differed significantly in BL Frailty score (0.29 vs 0.41, p.05). No significant differences were noted in BL disability per EQ5D-VAS (p>.05). In terms of baseline self-reported comorbidities in expired patients, the three most common for ASD patients were: arthritis (46%), hypertension (31%) and anemia (23%). In CD patients, the three most common comorbid conditions were: osteoporosis (50%), previous myocardial infarction (17%) and any cancer (17%). Complications analysis revealed no significant differences in major, minor or intraoperative complications between ASD or CD patients, nor between expired vs living patients (all p>.05). Similarly, there were no significant differences in mortality overall within 30 days, between 30 and 90 days, nor >90 days after surgery between ASD or CD patient cohorts (all p>.05). Regression analysis revealed that when accounting for age, BMI and gender, only frailty status remained a significant predictor of death overall (p=.047). Mean survival time for ASD was 84.11 weeks versus 65.17 in CD patients(χ2(1)=.748, p=.387). <h3>CONCLUSIONS</h3> Total 5-year all-cause mortality in adult spinal deformity and cervical deformity patients remains below 3% despite high rates of comorbidities, suggesting rigorous patient selection criteria plays an important role in maintaining the safety of such surgeries. This study demonstrates that while cervical deformity patients demonstrate greater incidence of death postoperatively, significantly increased baseline frailty status may be the principle cause of such results and should be considered when assessing surgical risks versus benefits. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Predictors of three months mortality after endovascular mechanical thrombectomy for acute ischemic stroke

ObjectiveThis study aims to determine predictive factors of mortality within 3 months after mechanical thrombectomy (MT) for patients with acute ischemic stroke (AIS).MethodsThis prospective cohort study was carried out at Assiut University stroke center in collaboration with Ain Shams University Egypt. Forty-four patients with anterior circulation AIS underwent MT between the first of January 2020 to the end of December 2020. They were evaluated for detection of death rates and identification of risks of 3-month mortality after MT.ResultsThis study comprised 44 patients (52.3% male) with a mean age of 64.3 years. The mean time from onset to femoral arterial puncture was 304.1 min. The mean Alberta Stroke Program Early CT Score (ASPECTS) and National Institutes of Health Stroke Scale (NIHSS) score were 9.3 and 19.2, respectively. The 3-month mortality rate was 13.6%. Univariate analyses found that higher baseline NIHSS score (mean 22.2 vs. 18.7, p = 0.021), absence of good collateral (16.7% vs. 68.4%, p = 0.02), longer duration of procedure ≥ 60 min (66.7% vs. 23.7%, p = 0.032), lower rates of successful recanalization (83.3% vs. 28.9%, p = 0.01) and developing symptomatic intracerebral hemorrhage (33.3% vs. 5.3%, p = 0.026) were associated with 3-month mortality. Multivariate analyses found that low rates of successful recanalization (OR 0.081; 95% CI 0.009–0.780, p = 0.030) remained significant independent predictive factor of 3-month mortality.ConclusionSuccessful recanalization was an independent predictor of 3-month mortality after MT.

Predictors of mortality in immunocompromised children with respiratory infections

Background Respiratory infection is a common morbidity and a major cause of mortality in immunocompromised children. Hence, identification of clinical parameters that predict mortality among immunocompromised children with respiratory infections is of importance to provide timely and appropriate intervention.&#x0D; Objective To determine predictors of mortality in immunocompromised children with respiratory infections.&#x0D; Methods We conducted a prospective cohort study of immunocompromised children aged 18 years or younger with respiratory tract infections who were admitted to Dr. Sardjito Hospital, Yogyakarta, Indonesia. All eligible children were prospectively followed up until hospital discharge. Clinical and laboratory parameters during the first 24 hours of hospitalization were collected.&#x0D; Results Of 79 eligible children, the overall mortality was 11 subjects (13.9%). Fever, tachycardia, tachypnea, cyanosis, leukopenia, neutropenia, thrombocytopenia, and pleural effusion were predictive factors of mortality in bivariate analysis (P&lt;0.25). A logistic regression model showed that neutropenia (absolute neutrophil count &lt;125/mm3) and tachycardia were the best independent predictors of mortality in immunocompromised children with respiratory infections. The children with tachycardia had 15.8 times higher probability of mortality (95%CI 5.0 to 4.4) and those with neutropenia had 8.24 times higher probability of mortality. Cyanosis and pleural effusion were also independent mortality predictors.&#x0D; Conclusion The risk of mortality is significantly increased in immunocompromised children with respiratory infection when tachycardia and neutropenia are also present.