Predictor Of In-hospital Outcomes Research Articles

Efficacy of Bedside Index for Severity In Acute Pancreatitis (Bisap) Score As Predictor of In-Hospital Outcome in Acute Pancreatitis

Background: Acute pancreatitis is a potentially life-threatening condition characterized by inflammation of the pancreas. Early identification of patients at risk of severe disease is crucial for devising appropriate management strategies and improving outcomes. The aim of the study was to investigate the efficacy of BISAP score as predictor of in-hospital outcome in patients with acute pancreatitis. Methods: This was a longitudinal study conducted in Department of Medicine, Sir Salimullah Medical College Mitford Hospital, Dhaka from January 2023 to December 2023. After ethical approval, a total 107 subjects were included in this study based on inclusion and exclusion criteria. Severity of the disease was assessed by BISAP score. Theoutcome determinants were length of hospital stay, complete recovery, partial recovery with complication, transfer to ICU and mortality. Chi Square test, Binominal Regression analysis and Receiver operator characteristic (ROC) curve analysis were performed as applicable. p value <0.05 was considered as the level of significance. Results: The mean BISAP score among 107 study participants was 2.00 ± 0.76. Patients with BISAP score ³3 had significantly increased odds of prolonged hospital stay (OR: 11.226; 95% CI: 2.985- 42.222; p<0.001), higher rate of partial recovery with complications (OR: 7.302; 95.325% CI: -20.997; p<0.001). <0.001), and greater likelihood of intensive care unit (ICU) transfer (OR: 1.136; 95% CI: 0.968-1.333; p=0.004). A BISAP score cutoff value of ³3 was associated with increased length of hospital stay (sensitivity 91.3%, specificity 97.6%, AUC=0.945), partial recovery with complications (sensitivity 83.3%, specificity 96.4%, AUC=0.899), and ICU transfer (sensitivity 75%, specificity 80.6%, AUC=0.778).Conclusion: It can be concluded that increased BISAP score can be served as an independent predictor of in-hospital in patients with acute pancreatitis (AP). Bangladesh J Medicine 2024; 35: 88-92

Mean Platelet Volume and Its Association With In-Hospital Outcomes in Patients With Acute ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.

Background Mean platelet volume (MPV), reflecting platelet size and activation, has been associated with cardiovascular disease (CVD) risk and mortality. Yet, its prognostic significance in acute coronary syndrome (ACS) patients undergoing primary percutaneous coronary intervention (PCI) remains uncertain. This study investigates whether elevated MPV levels upon admission in ST-segment elevation myocardial infarction (STEMI) patients predict adverse in-hospital outcomes after primary PCI. Objectives The aim of this study was to measure MPV in patients with STEMI who underwent primary PCI and to evaluate its association with in-hospital outcomes such as death, recurrent myocardial infarction, heart failure, and bleeding. Methods We enrolled 400 consecutive patients with STEMI (mean age 56.20 years, 356 males, 44 females) who underwent primary PCI at our center. We obtained MPV values from complete blood count tests performed at admission. We divided the patients into two groups based on the normal MPV range of 7.40 to 12 fL. We compared the baseline characteristics and in-hospital outcomes of the two groups. We used Cox proportional hazards regression analysis to adjust for potential confounders and evaluate the impact of MPV on in-hospital outcomes. Results There was no significant difference in MPV values between the two groups (9.10 ± 1.20 fL vs. 9.00 ± 1.10 fL, p = 0.54). Patients who died exhibited higher age, male predominance, hypertension, diabetes, a lower left ventricular ejection fraction, lower levels of low-density lipoprotein cholesterol, and lower levels of hemoglobin and hematocrit compared to survivors. MPV was not associated with any of the in-hospital outcomes in the unadjusted or adjusted analyses. Conclusion In this cohort of patients with STEMI who underwent primary PCI, admission MPV was not a predictor of in-hospital outcomes. Further studies are needed to clarify the role of MPV in the pathophysiology and prognosis of ACS.

Impact of residual coronary lesions on outcomes of myocardial infarction patients with multi-vessel disease

BackgroundThe residual burden of coronary artery disease (CAD) after percutaneous coronary intervention (PCI) drew a growing interest. The residual SYNTAX Score (rSS) was a strong prognostic factor of adverse events and all-cause mortality in patients who underwent PCI. In addition, the SYNTAX Revascularization Index (SRI), a derivative of rSS, was used to figure out the treated proportion of CAD and could be used as a prognostic utility in PCI for patients with multi-vessel disease (MVD).PurposeWe aimed at the assessment of the use of rSS and the SRI as predictors of in-hospital outcomes and up to two-year cumulative follow-up outcomes in patients with MVD who had PCI for the treatment of ST-Elevation Myocardial Infarction (STEMI) or Non-STEMI (NSTEMI).MethodsWe recruited 149 patients who had either STEMI or NSTEMI while having MVD and received treatment with PCI. We divided them into tertiles based on their rSS and SRI values. We calculated baseline SYNTAX Score (bSS) and rSS using the latest version of the calculator on the internet, and we used both scores to calculate SRI. The study end-points were In-hospital composite Major Adverse Cardiovascular Events (MACE) and its components, in-hospital death, and follow-up cumulative MACE up to 2 years.ResultsNeither rSS nor SRI were significant predictors of in-hospital adverse events, while female sex, hypertension, and left ventricular ejection fraction were independent predictors of in-hospital MACE. At the two-year follow-up, Kaplan-Meyer analysis showed a significantly increased incidence of MACE within the third rSS tertile (rSS > 12) compared to other tertiles (log rank p = 0.03). At the same time, there was no significant difference between the three SRI tertiles. Unlike SRI, rSS was a significant predictor of cumulative MACE on univariate Cox regression (HR = 1.037, p < 0.001). On multivariate Cox regression, rSS was a significant independent predictor of two-year cumulative MACE (HR = 1.038, p = 0.0025) along with female sex, hypertension, and left ventricular ejection fraction. We also noted that all patients with complete revascularization survived well throughout the entire follow-up period.ConclusionsNeither rSS nor SRI could be good predictors of in-hospital MACE, while the rSS was a good predictor of MACE at two-year follow-up. Patients with rSS values > 12 had a significantly higher incidence of cumulative MACE after 2 years. The best prognosis was achieved with complete revascularization.

In-hospital outcomes predictors and trends of redo sternotomy aortic root replacements: insights from a UK registry analysis.

Redo sternotomy aortic root surgery is technically demanding, and the evidence on outcomes is mostly from retrospective, small sample, single-centre studies. We report the trend, early clinical results and outcome predictors of redo aortic root replacement over 20 years in the United Kingdom. We retrospectively analysed collected data from the UK National Adult Cardiac Surgery Audit (NACSA) on all redo sternotomy aortic root replacements performed between 30th January 1998 and 19th March 2019. We analysed trends in the volume of operations, characteristics of hospital survivors vs. non-survivors, and predictors of in-hospital outcomes. During the study period, 1,107 redo sternotomy aortic root replacements were performed (median age 59, 26% of patients were females). Eighty-four per cent of cases (N = 931) underwent a composite root replacement, 11% (N = 119) had homograft root replacement and valve-sparing root replacement was performed in 5.1% (N = 57) of cases. There was a steady increase in the volume of redo sternotomy root replacements beyond 2006, from an annual volume of 22 procedures in 2006 to 106 procedures in 2017. Hospital mortality was 17% (n = 192), postoperative stroke or TIA occurred in 5.2% (n = 58), and postoperative dialysis was required in 11% (n = 109) of patients. Return to the theatre for bleeding/tamponade was required in 9% (n = 102) and median in-hospital stay was 9 days. Age >59 (OR: 2.99, CI: 1.92-4.65, P < 0.001), recent myocardial infarction (OR: 6.42, CI: 2.24-18.41, P = 0.001) were associated with increased in-hospital mortality. Emergency surgery (OR: 3.95, 2.27-6.86, P < 0.001), surgery for endocarditis (OR: 2.05, CI: 1.26-3.33, P = 0.001), salvage coronary artery bypass grafting (OR: 2.20, CI: 1.37-3.54, P < 0.001), arch surgery (OR: 2.47, CI: 1.30-3.61, P = 0.018) and aortic cross-clamp longer than 169 min (OR: 2.17, CI: 1.00-1.01, P = 0.003) were associated with increased risk of mortality. We found no effect of the centre or surgeon volume on mortality (P > 0.05). Redo sternotomy aortic root replacement still carries significant morbidity and mortality and is sporadically performed across surgeons and centres in the UK.

FRI-548 - Combination of CLIF-C ACLF and ammonia levels as a predictor of in-hospital outcomes in patients with acute-on-chronic liver failure

FRI-548 - Combination of CLIF-C ACLF and ammonia levels as a predictor of in-hospital outcomes in patients with acute-on-chronic liver failure

Predictors of In-hospital Outcomes in Hospitalized Patients With COPD Exacerbation

Background: Acute exacerbations of chronic obstructive pulmonary disease (COPD) are associated with significant mortality. Objectives: The present study aimed to identify the risk factors that contribute to hospital outcomes of patients admitted with COPD exacerbation. Methods: This prospective cross-sectional study was performed on 74 patients hospitalized with COPD exacerbation. Pulse oximetry, complete blood count, high-sensitivity C-reactive protein (hs-CRP), procalcitonin (PCT), and venous blood gas were taken under standard conditions. The clinical condition of patients was scored based on the COPD Assessment Test (CAT) and shortness of breath based on the standard, modified Medical Research Council (mMRC) questionnaire. The patients were divided into three groups based on in-hospital outcomes (i.e., favorable, unfavorable, and terrible or worse). One-way analysis of variance, chi-square test, logistic regression model, and odds ratio (OR) analysis were used to determine the most important factors associated with outcomes. A P-value less than 0.05 was considered statistically significant. Results: Out of 74 patients, 43 (58.1%) and 31 (41.9%) subjects were male and female, respectively. The patients’ mean age was 68.19 ± 10.62 years. The number (%) of patients in favorable, unfavorable, and worse outcome groups was 27 (36.48%), 30 (40.54%), and 17 (22.97%), respectively. As the CAT and mMRC score increased, the chance of terrible outcomes also increased (OR = 1.22, confidence interval (CI): 1.10 - 1.35). There was no significant correlation between worse outcomes and hs-CRP. The PCT was significantly higher in the group with worse outcomes than in the groups with favorable and unfavorable outcomes (P &lt; 0.01). Conclusions: The COPD evaluation by the CAT and mMRC plays an important role in the in-hospital outcomes of hospitalized COPD patients with exacerbation. The serum level of PCT was also a determinant factor of prognosis in hospitalized patients with COPD exacerbation.

Combination of CLIF-C ACLF and ammonia levels as a predictor of in-hospital outcomes in patients with acute-on-chronic liver failure

Combination of CLIF-C ACLF and ammonia levels as a predictor of in-hospital outcomes in patients with acute-on-chronic liver failure

Frailty as a Predictor of In-Hospital Outcome in Patients with Myocardial Infarction.

(1) Background: Frailty is a condition associated with aging, co-morbidity, and disability. We aimed to investigate the relationship between frailty and in-hospital outcome in patients with myocardial infarction (MI), including the occurrence of delirium, hospital-acquired pneumonia (HAP), and length of hospital stay. (2) Methods: We analyzed 55 patients ≥ 75 years old with ST-elevation and non-ST-elevation MI. Assessment with Abbreviated Mental Test Score (AMTS), Activity of Daily Living (ADL), Instrumental Activity of Daily Living (IADL) and Clinical Frailty Scale (CFS) was performed. (3) Results: In ROC analysis, IADL and CFS presented good predictive values for the occurrence of delirium (AUC = 0.81, p = 0.023, and AUC = 0.86, p = 0.009, respectively). For predicting HAP, only AMTS showed a significant value (AUC = 0.69, p = 0.036). In regression analyses, all tests presented significant predictive values for delirium. For predicting HAP, only IADL and CFS presented significant values (in an analysis adjusted for age, gender and type of MI). Frail patients (≥5 points in CFS) had longer hospital stays (10 days IQR: 8–17 vs. 8 days IQR: 7–10; p = 0.03). (4) Conclusions: While recognizing the limitations of our study associated with the relatively low sample size, we believe that our analysis shows that frailty is a predictor of poorer in-hospital outcomes in patients with MI, including higher rates of delirium, HAP and longer hospital stay.

D-34 | Trends of Endomyocardial Biopsy and Predictors of In-hospital Outcomes: National In-Patient Database Analysis from 2006 to 2017

BackgroundEndomyocardial biopsy (EMB) has limited indications based on expert consensus in new-onset fulminant heart failure, restrictive cardiomyopathies, and post-cardiac transplant. While generally considered a low-risk procedure, this depends on the patient's clinical state, the operator's experience, and cardiac pathologyexpertise. We sought to evaluate the temporal trend in EMB rates and inpatient outcomes.MethodsWe conducted a weighted analysis on EMB recipients (identified by ICD-9 and ICD-10-PCS codes) during their index hospitalization. We performed a trend analysis using the Cochran–Armitage test. We calculated adjusted odds ratios (aOR) to identify factors associated with inpatient mortality. A p-value < 0.05 was determined as statistically significant.ResultsWe found 64181 adult patients admitted for EMB between 2006 - 2017. The majority were 40 to 59 years old(41.8%), identified as white (62.8%), and male (68.7%). Inpatient mortality was 3.2% and the annual trend of EMB and its inpatient mortality remained stable over time. Coagulopathy aOR 3.18 (95% CI 2.61 – 3.87), electrolyte disturbances aOR 3.07 (95% CI 2.54 – 3.72), peripheral vascular disease aOR 3.08 (95% CI 2.31 – 4.10) and CHF aOR 2.28 (95% CI 1.80 – 2.87) increased the odds of inpatient mortality. The rate of iatrogenic cardiac tamponade (1.7%) and pneumothorax (1.2%) also remained stable.ConclusionsDisclosuresK. Quelal Nothing to disclose. A. Vij Nothing to disclose. BackgroundEndomyocardial biopsy (EMB) has limited indications based on expert consensus in new-onset fulminant heart failure, restrictive cardiomyopathies, and post-cardiac transplant. While generally considered a low-risk procedure, this depends on the patient's clinical state, the operator's experience, and cardiac pathologyexpertise. We sought to evaluate the temporal trend in EMB rates and inpatient outcomes. Endomyocardial biopsy (EMB) has limited indications based on expert consensus in new-onset fulminant heart failure, restrictive cardiomyopathies, and post-cardiac transplant. While generally considered a low-risk procedure, this depends on the patient's clinical state, the operator's experience, and cardiac pathologyexpertise. We sought to evaluate the temporal trend in EMB rates and inpatient outcomes. MethodsWe conducted a weighted analysis on EMB recipients (identified by ICD-9 and ICD-10-PCS codes) during their index hospitalization. We performed a trend analysis using the Cochran–Armitage test. We calculated adjusted odds ratios (aOR) to identify factors associated with inpatient mortality. A p-value < 0.05 was determined as statistically significant. We conducted a weighted analysis on EMB recipients (identified by ICD-9 and ICD-10-PCS codes) during their index hospitalization. We performed a trend analysis using the Cochran–Armitage test. We calculated adjusted odds ratios (aOR) to identify factors associated with inpatient mortality. A p-value < 0.05 was determined as statistically significant. ResultsWe found 64181 adult patients admitted for EMB between 2006 - 2017. The majority were 40 to 59 years old(41.8%), identified as white (62.8%), and male (68.7%). Inpatient mortality was 3.2% and the annual trend of EMB and its inpatient mortality remained stable over time. Coagulopathy aOR 3.18 (95% CI 2.61 – 3.87), electrolyte disturbances aOR 3.07 (95% CI 2.54 – 3.72), peripheral vascular disease aOR 3.08 (95% CI 2.31 – 4.10) and CHF aOR 2.28 (95% CI 1.80 – 2.87) increased the odds of inpatient mortality. The rate of iatrogenic cardiac tamponade (1.7%) and pneumothorax (1.2%) also remained stable. We found 64181 adult patients admitted for EMB between 2006 - 2017. The majority were 40 to 59 years old(41.8%), identified as white (62.8%), and male (68.7%). Inpatient mortality was 3.2% and the annual trend of EMB and its inpatient mortality remained stable over time. Coagulopathy aOR 3.18 (95% CI 2.61 – 3.87), electrolyte disturbances aOR 3.07 (95% CI 2.54 – 3.72), peripheral vascular disease aOR 3.08 (95% CI 2.31 – 4.10) and CHF aOR 2.28 (95% CI 1.80 – 2.87) increased the odds of inpatient mortality. The rate of iatrogenic cardiac tamponade (1.7%) and pneumothorax (1.2%) also remained stable. Conclusions DisclosuresK. Quelal Nothing to disclose. A. Vij Nothing to disclose. K. Quelal Nothing to disclose. A. Vij Nothing to disclose.

Predictors of In-hospital Outcomes in Patients with Cirrhosis and Coronavirus Disease-2019

Background: Coronavirus disease-2019 (COVID-19) cases continue to increase globally. Poor outcomes in patients with COVID-19 and cirrhosis have been reported; predictors of outcome are unclear. The existing data is from the early part of the pandemic when variants of concern (VOC) were not the major circulating strains. Aims: We aimed to assess the outcomes and predictors in patients with cirrhosis and COVID-19. We also compared the differences in outcomes between the first wave of pandemic and the second wave. Methods: In this retrospective analysis of a prospectively maintained database, data on consecutive cirrhosis patients (n=221) admitted to the COVID-19 care facility of a tertiary care center in India were evaluated for presentation, severity of liver disease, severity of COVID-19, and outcomes. Results: The clinical presentation included: 18 (8.1%) patients had compensated cirrhosis, 139 (62.9%) acute decompensation (AD), and 64 (29.0%) had acute-on-chronic liver failure (ACLF). Patients with ACLF had more severe COVID-19 infection than those with compensated cirrhosis and AD (54.7% vs 16.5% and 33.3%, P< 0.001). The overall mortality was 90 (40.7%), highest among ACLF (71.9%). On multivariate analysis, independent predictors of mortality were high leukocyte count, alkaline phosphatase, creatinine, child class, model for end-stage liver disease (MELD) score and COVID-19 severity. The second wave had more cases of severe COVID-19 as compared to the first wave, with similar MELD score and child score. The overall mortality was similar between the two waves. Conclusion: Patients with COVID-19 and cirrhosis have high mortality (40%), particularly those with ACLF (72%). A higher leukocyte count, creatinine, alkaline phosphatase, Child class, and MELD score are predictors of mortality.

Predictors of outcome in spontaneous intracerebral hemorrhage with special reference to hyponatremia

Objective: The study was done to find the various clinical, biochemical and radiological predictors of outcome in spontaneous intracerebral hemorrhage (SICH) patients and to assess the role of hyponatremia as a predictor of in-hospital mortality. Materials and Methods: This was a hospital based prospective observational study conducted in the department of Medicine, VMMC and Safdarjang Hospital, New Delhi, India on 75 adults (>18 years of age, both male and female) presenting with SICH. Various parameters comprising demographic, clinical, laboratory, and radiological variables along with stroke severity were assessed and studied as predictors of in-hospital outcome, i.e., mortality and disability at the time of discharge as assessed by modified Rankin's Scale (mRS) in 75 SICH patients presenting to the emergency department. Furthermore, the role of hyponatremia as a predictor of in-hospital mortality was studied. Results: Out of 75 patients enrolled in the study, 40% (n = 30) of the patients died in the hospital and 60% (n = 45) were discharged. Out of the discharged category, 80% (n = 36) had mild disability with mRS 1–3 and 20% (n = 9) had moderate-to-severe disability with mRS 4-5. National Institute of Health Stroke Scale (NIHSS) at the time of hospitalization was found to be the significant independent predictor of in-hospital mortality and higher mRS score at discharge. Furthermore, Glasgow Coma Scale (GCS) ≤4 and NIHSS >12 were significantly associated with in-hospital mortality. Hyponatremia was found in 44% (n = 33) of the patients at the time of hospitalization and out of them sodium level got corrected in 15.15% (n = 5). Out of the 42 normonatremic patients 31% (n = 13) developed hyponatremia in subsequent days during hospitalization. No association was found between hyponatremia and in-hospital mortality. Conclusion: Our study highlights the fact that SICH is associated with high in-hospital mortality. NIHSS score at the time of hospitalization is an independent predictor of in-hospital mortality and disability at discharge. Furthermore, GCS ≤4 and NIHSS >12 are significantly associated with in-hospital mortality. Although hyponatremia is a common occurrence in patients with SICH, our study failed to show association between hyponatremia and in-hospital mortality.

Predictors of In-Hospital Outcome in Initially Hemodynamially Stable Adults with Non–STSegment–Elevation Myocardial Infarction

Predictors of In-Hospital Outcome in Initially Hemodynamially Stable Adults with Non–STSegment–Elevation Myocardial Infarction

Predictors of in-hospital Outcomes in Patients With Cirrhosis and Coronavirus Disease-2019

BackgroundCoronavirus disease-2019 (COVID-19) cases continue to increase globally. Poor outcomes in patients with COVID-19 and cirrhosis have been reported; predictors of outcome are unclear. The existing data is from the early part of the pandemic when variants of concern (VOC) were not reported.AimsWe aimed to assess the outcomes and predictors in patients with cirrhosis and COVID-19. We also compared the differences in outcomes between the first wave of pandemic and the second wave.MethodsIn this retrospective analysis of a prospectively maintained database, data on consecutive cirrhosis patients (n = 221) admitted to the COVID-19 care facility of a tertiary care center in India were evaluated for presentation, the severity of liver disease, the severity of COVID-19, and outcomes.ResultsThe clinical presentation included: 18 (8.1%) patients had compensated cirrhosis, 139 (62.9%) acute decompensation (AD), and 64 (29.0%) had an acute-on-chronic liver failure (ACLF). Patients with ACLF had more severe COVID-19 infection than those with compensated cirrhosis and AD (54.7% vs. 16.5% and 33.3%, P < 0.001). The overall mortality was 90 (40.7%), the highest among ACLF (72.0%). On multivariate analysis, independent predictors of mortality were high leukocyte count, alkaline phosphatase, creatinine, child class, model for end-stage liver disease (MELD) score, and COVID-19 severity. The second wave had more cases of severe COVID-19 as compared to the first wave, with a similar MELD score and Child score. The overall mortality was similar between the two waves.ConclusionPatients with COVID-19 and cirrhosis have high mortality (40%), particularly those with ACLF (72%). A higher leukocyte count, creatinine, alkaline phosphatase, Child class, and MELD score are predictors of mortality.

Incremental predictive value of adding the CHA2DS2-VASc score to the GRACE score for in-hospital mortality in patients with ST-segment elevation myocardial infarction

Abstract Objective The Global Registry of Acute Coronary Events (GRACE) score is recommended for risk stratification for patients with ST-segment elevation myocardial infarction (STEMI) by clinical guidelines. Data about comorbidities were not incorporated in the GRACE score. This study aimed to evaluate the incremental predictive value of adding the CHA2DS2-VASc score to the GRACE score for in-hospital mortality in patients with STEMI. Methods 7476 patients with STEMI were recruited and divided into five groups according to the CHA2DS2-VASc score (1, 2, 3, 4 and ≥5 points) at admission. The primary outcome was defined as in-hospital mortality, while the secondary outcomes were recurrent MI, stroke and major adverse cardiovascular events (MACE) during hospitalization. Univariate and multivariate logistic regression were performed to evaluate the association between the CHA2DS2-VASc score and outcomes. Incremental predictive performance of adding the CHA2DS2-VASc score to the GRACE score were evaluated through analysis of the receiver operating characteristic (ROC) curves, net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Results With the increase of CHA2DS2-VASc score, patients with STEMI tended to have more comorbidities, receive less evidence-based treatments and carry worse in-hospital outcomes. Multivariate logistic regressions demonstrated that the CHA2DS2-VASc score was an independent predictor for in-hospital mortality [OR (95% CI): 1.320 (1.238–1.407), p&amp;lt;0.001], recurrent myocardial infarction [OR (95% CI): 1.233 (1.086–1.401), p=0.001], stroke [OR (95% CI): 1.433 (1.207–1.702), p&amp;lt;0.001] and MACE [OR (95% CI): 1.146 (1.088–1.207), p&amp;lt;0.001]. The c statistic value of combining the GRACE score with the CHA2DS2-VASc score was significantly higher than that of the GRACE score alone in predicting in-hospital mortality (0.784, 95% CI: 0.774–0.793 vs. 0.769, 95% CI: 0.760–0.779, z=4.180, p&amp;lt;0.001). The addition of the CHA2DS2-VASc score to the GRACE score resulted in significantly improved predictive performance for in-hospital mortality, with a NRI of 0.356 (95% CI: 0.280–0.432, p&amp;lt;0.001) and a IDI of 0.013 (95% CI: 0.009–0.018, p&amp;lt;0.001). Conclusion The CHA2DS2-VASc score was an independent predictor of in-hospital outcomes in patients with STEMI. Compared to the GRACE score alone, the addition of the CHA2DS2-VASc score to the GRACE score improved the predictive performance for in-hospital mortality in patients STEMI. Funding Acknowledgement Type of funding sources: None. Receiver operating characteristic curve

Predictors of In-Hospital Outcomes among Octogenarians with Acute ST-elevation Myocardial Infarction at the Philippine Heart Center.

Predictors of In-Hospital Outcomes among Octogenarians with Acute ST-elevation Myocardial Infarction at the Philippine Heart Center.

Pre-operative physical performance as a predictor of in-hospital outcomes in older patients undergoing elective cardiac surgery

ObjectiveRisk stratification of cardiac surgery patients is usually based on the Society of Thoracic Surgeons (STS) score, that has limited predictive value in older persons. We aimed assessing whether the Short Physical Performance Battery (SPPB) improves, beyond the STS score, assessment of hospital prognosis in older patients undergoing elective cardiac surgery. MethodsAll patients aged 75+ years referred for elective cardiac surgery to Careggi University Hospital (Florence, Italy) from April 2013 to March 2017 were evaluated pre-operatively. Participants were classified according to the STS-Predicted Risk Of Mortality (STS-PROM): low (<4%), intermediate (4 to 8%), and high risk (>8%). Primary study outcomes were hospital mortality and STS-defined major morbidity. Length of hospital stay was an additional outcome. ResultsOut of 235 participants (females: 46.5%; mean age: 79.6 years), 144 (61.3%) were at low, 67 (28.5%) at intermediate and 24 (10.2%) at high risk, based on the STS-PROM. SPPB (mean±SEM) was 8.8 ± 0.2, 7.0 ± 0.5, and 6.0 ± 0.8 in participants at low, intermediate, and high risk, respectively (p<0.001). The primary outcome occurred in 62 participants (26.4%). In low-risk participants, the SPPB score predicted the primary endpoint (adjusted OR 0.77, 95% CI 0.66–0.89 per each point increase; p<0.001) controlling for STS-Major Morbidity or Operative Mortality (STS-MM) score. This result was not observed in the intermediate-high risk group. ConclusionsSPPB predicts mortality and major morbidity in older patients undergoing elective cardiac surgery, classified as low risk with the STS risk score. The SPPB, applied preoperatively, might improve risk stratification in older patients undergoing elective cardiac surgery.

P5983Pre-operative physical performance as an independent predictor of in-hospital outcomes in older patients undergoing elective cardiac surgery

Abstract Introduction Risk stratification of patients candidate to cardiac surgery is usually based on the Society of Thoracic Surgeons (STS) score or on the Euroscore II. However, these risk scores has limited predictive value in elderly patients. Purpose We conducted a study to determine whether the Short Physical Performance Battery (SPPB), a tool assessing physical performance, predicts hospital death and major morbidity, beyond STS risk score. The outcome was a composite end-point as defined by STS Major Morbidity or Operative Mortality (STS-MM) in STS Risk Model Outcomes: operative mortality, stroke, renal failure, prolonged mechanical ventilation, deep sternal wound infection, and reoperation. Methods In this prospective, single-center, cohort, hospital-based study, conducted at Careggi University Hospital, Florence, Italy, all patients aged 75+ years referred for an elective coronary aortic by-pass grafting, valvular surgery or combined cardiac surgery were evaluated pre-operatively. Assessment included SPPB, cognitive and functional status and evaluation of comorbidity. Patients receiving emergency/urgent cardiac surgery or a procedure not considered in the STS risk score calculator, who reported previous cardiac surgery or were clinically unstable were excluded. Participants were classified according to the STS-Predicted Risk Of Mortality (STS-PROM) as at low (&lt;4%), intermediate (4 to 8%) or high risk (&gt;8%). Results Out of 250 participants (females: 48.4%; mean age: 79.9 years), 148 (59.2%) were at low, 73 (29.2%) at intermediate and 29 (11.6%) at high risk, based on the STS-PROM. Mean±SEM SPPB score was 8.8±0.2, 7.1±0.4 and 6.0±0.7 in participants at low, intermediate, and high risk, respectively (p&lt;0.001). The outcome occurred in 67 subjects (26.8%). SPPB score predicted the outcome in the entire study sample, controlling for STS-MM score, CKD, and anaemia (adjusted OR: 0.89, 95% CI 0.81–0.98 per each point increase; p 0.017). When analyses were repeated separately in participants with STS-PROM indicative of low (&lt;4%) and in those at medium-high risk, the predictive value of SPPB was enhanced in the formers (adjusted OR 0.73, 95% CI 0.62–0.86 per each point increase; p&lt;0.001- controlling for STS score), whereas was lost in the latter. An alternative model was subsequently tested, where STS score was not included and peripheral artery disease and creatinine (variables contributing to the STS score) were individually entered: SPPB was confirmed as a significant predictor also in this model, controlling for anaemia, peripheral artery disease, and creatinine. The corresponding AUC was 0.813 (Figure 1). Figure 1 Conclusions SPPB predicts mortality and major morbidity in older patients undergoing elective cardiac surgery, in particular in those classified as low-risk with the STS risk score. Use of SPPB should therefore be recommended to improve preoperative risk stratification of older patients.

Formulation of a Three-Tier Cisternal Grade as a Predictor of In-Hospital Outcome from a Prospective Study of Patients with Traumatic Intracranial Hematoma- A review report.

Traumatic brain injury (TBI) is an escalating problem with an almost geometric progression. The problem escalated with increasing population and traffic, but with limited resources to handle the issue.1,2 The present study has its objective focused on making a prognosis of the TBI patient.3 The outcome prediction helps in conveying the prognosis to the patient’s family. Needless to say, a prognostic prediction is also helpful in the optimal and timely utilization of available resources.

Formulation of a Three-Tier Cisternal Grade as a Predictor of In-Hospital Outcome from a Prospective Study of Patients with Traumatic Intracranial Hematoma- A review report

Formulation of a Three-Tier Cisternal Grade as a Predictor of In-Hospital Outcome from a Prospective Study of Patients with Traumatic Intracranial Hematoma- A review report

Technical Performance Score Predicts Partial/Transitional Atrioventricular Septal Defect Outcomes

Repair of partial or transitional atrioventricular septal defects (P/TAVSDs) has excellent outcomes; however, late reinterventions remain a concern. Technical performance score (TPS) measures residua after repair and has been associated with early/mid-term outcomes after congenital cardiac operation. Our studyinvestigates TPS as a predictor of outcomes after P/TAVSD repair. This was a single-center retrospective review of P/TAVSD repair from July 2000 to November 2015. Intraoperative and discharge TPS were assigned based on echocardiographic criteria: class 1, no residua; class 2, minor residua; and class 3, major residua or reintervention for major residua. Intensive care unit (ICU) hospital length of stay and reintervention after discharge were analyzed with Cox regression. In our cohort, 124 partial (68%) and 59 transitional (32%) AVSDs underwent repair. Median age was 1.5 years (interquartile range [IQR]: 0.6 to 3.8 years), median weight was 9.7 kg (IQR: 6.6 to 14.1 kg), and 96 (52%) were female. Twenty patients (11%) required reintervention after discharge. On multivariable modeling, patients with TPS class 3 spent more days in the ICU (hazard ratio [HR] 0.33, 95% confidence interval [CI]: 0.19 to 0.58, p < 0.001) and hospital (HR 0.33, 95% CI: 0.19 to 0.57, p < 0.001) and had shorter time to reintervention after discharge (HR 8.76, 95% CI: 1.03 to 74.7, p=0.047). Major residua, that is TPS class 3, were a predictor of in-hospital outcomes and unplanned reinterventions after discharge, with left atrioventricular valve regurgitation being the strongest predictor. Use of TPS as a tool for residual lesions may identify patients predisposed to prolonged ICU hospital stay and reinterventions after discharge, providing feedback on areas in need of improvement in technique and identification of patients who warrant closer follow-up.