Primary Outcome Of In-hospital Mortality Research Articles

Uncovering Risk Factors and Outcomes of Pulmonary Embolism in a Nationwide Cohort of Hospitalized Children.

The incidence of pulmonary embolism (PE) in hospitalized children has increased in recent years. This study sought to characterize factors and outcomes associated with PE using a national pediatric cohort. The Nationwide Readmissions Database was queried (2016-2018) for patients (<18years) with a diagnosis of PE. Index and prior hospitalizations (PHs) within 1year were analyzed. A binary logistic regression utilizing 37 covariates (demographics, procedures, comorbidities, etc.) was constructed to examine a primary outcome of in-hospital mortality. 3440 patients were identified (57% female) with the majority >12years old (77%). One-third had a known deep vein thrombosis (69% lower and 31% upper extremity). Nineteen percent underwent central venous catheter (CVC) placement. Twenty-one percent had a PH within 1year. Nine percent underwent an operation with the majority being cardiothoracic (5%). Overall mortality was 5%. Neurocranial surgery, cardiothoracic surgery, and CVC placement were associated with the highest odds of inpatient mortality after logistic regression. Pediatric patients with PE have a high rate of PHs, CVC placement, and inpatient operations, which may be associated with higher mortality. This information can be utilized to improve screening measures and clinical suspicion for PE in hospitalized children.

Early versus delayed introduction of renin angiotensin aldosterone system inhibitors in cardiogenic shock

Abstract Background There is currently no recommendation on the appropriate timing of introduction of renin angiotensin aldosterone system inhibitors (RAASi) in patients admitted with cardiogenic shock. Purpose To describe the timing of introduction of RAASi during cardiogenic shock and its association with mortality. Methods We analyzed patients admitted with cardiogenic shock and treated with RAASi between January 1st, 2010, and December 31st, 2020, in our tertiary shock center. The characteristics and outcomes of patients with early RAASi introduction (≤ 3 days from admission) were compared with those who had a delayed RAASi introduction (&amp;gt; 3 days). Inverse propensity score was used to compare the primary outcome of in-hospital mortality. All-cause death or readmission for heart failure/cardiogenic shock was evaluated up to June 1st, 2022. Results The study population included 406 shock patients, 53% (n=215 patients) with early RAASi introduction and 47% (n=191 patients) in the delayed introduction group. Patients treated with early RAASi (vs. delayed introduction) were more frequently admitted for an acute myocardial infarction (53 % vs. 35 %) (p&amp;lt;0.01), had a better left ventricular fraction (LVEF 22% vs. 20 %) (P=0.001) and had less frequently chronic kidney disease (3.2 % vs. 9.4%) (p&amp;lt;0.01). Early RAASi introduction was associated with a higher in-hospital mortality (OR 6.47 (95% CI) 3.4 - 13.4, p&amp;lt;0.001) as compared with delayed introduction (figure 1). Each day of delay before introduction of RAASi was associated with a reduction of in-hospital mortality OR 0.80 95 % CI (0.69 - 0.89) (p&amp;lt;0.01). After a median follow up of 11 (2 – 48) months, there was no difference in the risk of death or heart failure between both strategies (p=0.89) (figure 2). Conclusion Early RAASi introduction during cardiogenic shock was associated with a higher in-hospital mortality, without apparent benefits during the year after discharge. Randomized studies are needed to evaluate the optimal time and dose management of RAAS inhibitors in cardiogenic shock.

Comparative Analysis of Clinical Outcomes for COVID-19 and Influenza among Cardiac Transplant Recipients in the United States.

COVID-19 infections can lead to worse outcomes in an immunocompromised population with multiple comorbidities, e.g., heart transplant patients. We used the National Inpatient Sample database to compare heart transplant outcomes in patients with COVID-19 vs. influenza. A total of 2460 patients were included in this study: heart transplant with COVID-19 (n = 1155, 47.0%) and heart transplant with influenza (n = 1305, 53.0%) with the primary outcome of in-hospital mortality. In-hospital mortality (n = 120) was significantly higher for heart transplant patients infected with COVID-19 compared to those infected with influenza (9.5% vs. 0.8%, adjusted OR: 51.6 [95% CI 4.3-615.9], p = 0.002) along with significantly higher rates of mechanical ventilation, acute heart failure, ventricular arrhythmias, and higher mean total hospitalization cost compared to the influenza group. More studies are needed on the role of vaccination and treatment to improve outcomes in this vulnerable population.

Abstract P3110: Sex Differences In Ventricular Tachycardia Ablation In-hospital Outcomes: An Analysis From The National Inpatient Sample Database

Background: There are limited data available comparing outcomes of ventricular tachycardia (VT) ablation in men versus women. Objectives: For patients undergoing ablation for VT, we sought to determine if sex-based differences in outcomes and procedural complications exist. Methods: We queried the National Inpatient Sample (NIS) database between 2016 and 2018 to identify patients aged ≥18 years hospitalized with a primary diagnosis of VT who underwent ablation. Patients with other cardiac arrhythmias or who had an implantable defibrillator/pacemaker placement were excluded. Multivariable logistic regression analysis was performed to assess independent predictors of any procedural complication. Results: Out of 7,200 identified admissions for VT involving VT ablation, 1,280 (18%) were women and 5920 (82%) were men. Men were older (mean age 64.8 vs 57.4 years in women, P&lt;0.01). Comorbidities as prior myocardial infarction (MI), prior CABG, Chronic kidney disease (CKD), COPD, prior cardiac pacemaker, chronic heart failure (CHF) and peripheral vascular disease (PVD) were all significantly more prevalent in men.The primary outcome of in-hospital mortality occurred in 3% of both men and women. Interestingly, the length of stay was longer in men (6.53±4.2 vs 5.26±2.5 days, p&lt;0.01). The incidence of acute MI, acute ischemic stroke, bleeding, need of blood transfusion, tamponade, complete heart block, pulmonary complications, vascular complications similar between men and women, however acute kidney injury occurred more in men (21% vs. 10%, p&lt; 0.001). The overall complication rate was significantly higher in men (28.8% vs 20.7 %, P= 0.0084). The presence of CKD, as well as CHF were independent predictors of any procedural complication (OR 1.27, 95% CI 1.19-1.36, P &lt;0.01) and (OR 1.08, 95% CI 1.03-1.14, P=0.001). Conclusion: Men had higher rates of in hospital complications following VT ablation which might be related to higher rates of comorbidities. There was no difference in in-hospital mortality between men and women. Women represented only 17.8% of VT ablation admissions. Further studies are needed to distinguish the sex-based differences in VT ablation referrals and to compare long term outcomes post ablation.

External validation of the ISARIC 4C Mortality Score to predict in-hospital mortality among patients with COVID-19 in a Canadian intensive care unit: a single-centre historical cohort study.

With uncertain prognostic utility of existing predictive scoring systems for COVID-19-related illness, the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) 4C Mortality Score was developed by the International Severe Acute Respiratory and Emerging Infection Consortium as a COVID-19 mortality prediction tool. We sought to externally validate this score among critically ill patients admitted to an intensive care unit (ICU) with COVID-19 and compare its discrimination characteristics to that of the Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores. We enrolled all consecutive patients admitted with COVID-19-associated respiratory failure between 5 March 2020 and 5 March 2022 to our university-affiliated and intensivist-staffed ICU (Jewish General Hospital, Montreal, QC, Canada). After data abstraction, our primary outcome of in-hospital mortality was evaluated with an objective of determining the discriminative properties of the ISARIC 4C Mortality Score, using the area under the curve of a logistic regression model. A total of 429 patients were included, 102 (23.8%) of whom died in hospital. The receiver operator curve of the ISARIC 4C Mortality Score had an area under the curve of 0.762 (95% confidence interval [CI], 0.717 to 0.811), whereas those of the SOFA and APACHE II scores were 0.705 (95% CI, 0.648 to 0.761) and 0.722 (95% CI, 0.667 to 0.777), respectively. The ISARIC 4C Mortality Score is a tool that had a good predictive performance for in-hospital mortality in a cohort of patients with COVID-19 admitted to an ICU for respiratory failure. Our results suggest a good external validity of the 4C score when applied to a more severely ill population.

In-hospital outcomes of PCI in patients who have ESRD vs non-ESRD patients, a retrospective study involving a National Inpatient Sample (NIS) database

BackgroundCardiovascular disease is the leading cause of death for patients with end-stage renal disease (ESRD). ESRD is known to affect a large portion of the American population. Previous data for patients undergoing percutaneous coronary intervention (PCI) in the setting of ESRD for Acute Coronary Syndrome (ACS) and non-ACS etiologies have shown to have an increase in in-hospital mortality, and prolonged hospitalization among other complications. MethodsThe national inpatient sample (NIS) was used to identify patients who underwent PCI between the years 2016–2019. Patients were then grouped into those with ESRD on renal replacement therapy (RRT). Logistic regression models were employed to assess the primary outcome of in-hospital mortality, while linear regression models were utilized to evaluate secondary outcomes, including hospitalization cost and length of stay. ResultsA total of 21,366 unweighted observations were initially included, consisting of 50 % ESRD patients and 50 % randomly selected patients without ESRD who underwent PCI. These observations were weighted to represent a national estimate of 106,830 patients. The mean age of the study population was 65 years, and 63 % of the patients were male. The ESRD group had a greater representation of minority groups compared to the control group. The in-hospital mortality rate was significantly higher in the ESRD group compared to the control group, with an odds ratio of 1.803 (95 % CI: 1.502 to 2.164; p-value of 0.0002). Additionally, the ESRD group had significantly higher healthcare costs and longer length of stay, with a mean difference of $47,618 (95 % CI: $42,701 to $52,534, p-value <0.0001) and 2.933 days (95 % CI, 2.729 to 3.138 days, p-value <0.0001), respectively. ConclusionIn-hospital mortality, cost, and length of stay for patients undergoing PCI were found to be significantly greater in the ESRD group.

Body mass index and its association with COVID-19 clinico-neurological outcomes: Findings from the Philippine CORONA study (P5-10.005)

<h3>Objective:</h3> To explore the association between body mass index (BMI) and clinico-neurological outcomes in a large cohort of patients with coronavirus disease 2019 (COVID-19). <h3>Background:</h3> We hypothesize that either abnormally low or high BMI significantly affects clinical and neurologic outcome measures in this subset of patients. <h3>Design/Methods:</h3> This is a secondary analysis of a 37-site, nationwide, multicenter, retrospective cohort study that investigated the clinical and neurological outcomes of adult patients with confirmed COVID-19 admitted from February to December 15, 2020. <h3>Results:</h3> We analyzed 4,463 patients with BMI and outcome data. A total of 790 (17.7%) and 710 (15.9%) had the primary outcome of in-hospital mortality and need for invasive mechanical ventilation (IMV), respectively. There was no significant association between WHO BMI groups and these outcomes. Using Asia-Pacific cutoffs showed a significant association between obesity and in-hospital mortality risk (P = 0.012). Being underweight was an independent predictor of prolonged IMV requirement regardless of BMI criteria used (P &lt; 0.01). Obesity correlated with the need for intensive care unit admission using Asia-Pacific cutoffs (P = 0.029). There was a significant association between any BMI abnormality and odds of severe/critical COVID-19 (P &lt; 0.05). Obese patients with concomitant acute neurological presentation/diagnosis during their COVID-19 admission were shown to have lower odds of neurologic recovery (P &lt; 0.05). <h3>Conclusions:</h3> We found BMI abnormalities to be associated with several adverse clinical and neurologic outcomes, although such associations may be more evident with the use of race-specific BMI criteria. <b>Disclosure:</b> Dr. Espiritu has nothing to disclose. Dr. Reyes has nothing to disclose. Carl Froilan Leochico has nothing to disclose. Marie Charmaine Sy has nothing to disclose. Emilio Villanueva III has received personal compensation in the range of $500-$4,999 for serving as a Consultant for LabX Corporation. Michelle Anlacan has received personal compensation in the range of $0-$499 for serving as a Consultant for Torrent Philippines. Michelle Anlacan has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Medichem Philippines. Michelle Anlacan has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Hi Eisai Philippines. Michelle Anlacan has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Natrapharm Philippines. Michelle Anlacan has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Alzheimer’s disease association of the philippines. Michelle Anlacan has received research support from Philippine Council for Health Research and Development. Michelle Anlacan has received research support from Philippine Neurological Association. Roland Dominic Jamora has received personal compensation in the range of $500-$4,999 for serving as a Consultant for torrent. Roland Dominic Jamora has received research support from CCXDP.

Association between the timing of ICU admission and mortality in patients with hospital-onset sepsis: a nationwide prospective cohort study

BackgroundBased on sparse evidence, the current Surviving Sepsis Campaign guideline suggests that critically ill patients with sepsis be admitted to the intensive care unit (ICU) within 6 h. However, limited ICU bed availability often makes immediate transfer difficult, and it is unclear whether all patients will benefit from early admission to the ICU. Therefore, the purpose of this study was to determine the association between the timing of ICU admission and mortality in patients with hospital-onset sepsis.MethodsThis nationwide prospective cohort study analyzed patients with hospital-onset sepsis admitted to the ICUs of 19 tertiary hospitals between September 2019 and December 2020. ICU admission was classified as either early (within 6 h) or delayed (beyond 6 h). The primary outcome of in-hospital mortality was compared using logistic regression adjusted for key prognostic factors in the unmatched and 1:1 propensity-score-matched cohorts. Subgroup and interaction analyses assessed whether in-hospital mortality varied according to baseline characteristics.ResultsA total of 470 and 286 patients were included in the early and delayed admission groups, respectively. Early admission to the ICU did not significantly result in lower in-hospital mortality in both the unmatched (adjusted odds ratio [aOR], 1.35; 95% confidence interval [CI], 0.99–1.85) and matched cohorts (aOR, 1.38; 95% CI, 0.94–2.02). Subgroup analyses showed that patients with increasing lactate levels (aOR, 2.10; 95% CI, 1.37–3.23; P for interaction = 0.003), septic shock (aOR, 2.06; 95% CI, 1.31–3.22; P for interaction = 0.019), and those who needed mechanical ventilation (aOR, 1.92; 95% CI, 1.24–2.96; P for interaction = 0.027) or vasopressor support (aOR, 1.69; 95% CI, 1.17–2.44; P for interaction = 0.042) on the day of ICU admission had a higher risk of mortality with delayed admission.ConclusionsAmong patients with hospital-onset sepsis, in-hospital mortality did not differ significantly between those with early and delayed ICU admission. However, as early intensive care may benefit those with increasing lactate levels, septic shock, and those who require vasopressors or ventilatory support, admission to the ICU within 6 h should be considered for these subsets of patients.

Coronary Stent Infections — A Systematic Review and Meta-Analysis

BackgroundCoronary stent infection (CSI) represents a rare but potentially fatal complication of percutaneous coronary interventions (PCI). A systematic review and meta-analysis of published reports was performed to profile CSI and its management strategies. MethodsOnline database searches were performed using MeSH and keywords. The primary outcome of the study was in-hospital mortality. A unique Artificial Intelligence-based predictive model was developed for need for delayed surgery and probability of survival on medical therapy alone. ResultsA total of 79 subjects were included in the study. Twenty eight (35.0 %) patients had type 2 diabetes mellitus. Subjects most commonly reported symptoms within the first week of the procedure (43 %). Fever was the most common initial symptom (72 %). Thirty eight percent of patients presented with acute coronary syndrome. The presence of mycotic aneurysms was described in 62 % of patients. Staphylococcus species were the most common (65 %) isolated organism. The primary outcome of in-hospital mortality was seen in a total of 24 patients out of 79 (30.3 %). A comparative univariate analysis comparing those encountering in-hospital mortality versus otherwise revealed the presence of structural heart disease (83 % mortality vs 17 % survival, p = 0.009), and the presence of non ST elevation acute coronary syndrome (11 % mortality vs 88 % survival, p = 0.03), to be a statistically significant factor predicting in-hospital mortality. In an analysis between patients with successful versus failed initial medical therapy, patients from private teaching hospitals (80.0 % vs 20.0 %; p = 0.01, n = 10) had a higher survival with medical therapy alone. ConclusionCSI is a highly under-studied disease entity with largely unknown risk factors and clinical outcomes. Larger studies are needed to further define the characteristics of CSI. (PROSPERO ID CRD42021216031).

Sex differences in atrial fibrillation ablation in-hospital outcomes from the National Inpatient Sample database 2016-2019.

Research has shown mixed results when comparing in-hospital complications following atrial fibrillation ablation in women compared to men. To better quantify sex differences and in-hospital outcomes in atrial fibrillation ablation procedures and identify factors associated with poorer outcomes. We queried the NIS database from 2016 to 2019 for hospitalizations with a primary diagnosis of atrial fibrillation ablation and excluded patients with any other arrhythmias, ICD/pacemaker placement. We assessed demographics, in-hospital mortality, and complications of women compared to men. Admissions for atrial fibrillation were more common in females than males (849 050 vs. 815 665; p < .001). However, females were less likely to receive ablation (1.65% vs. 2.71%, OR: 0.60; 95% confidence interval: 0.57-0.64, p < .001), which persisted after adjusting for cardiomyopathy (adjusted OR: 0.61; 95% confidence interval: 0.58-0.65, p < .001). The primary outcome of in-hospital mortality was not statistically different in univariate analysis (0.39% vs. 0.36%, OR: 1.09, 95% CI: 0.44-2.72, p=.84), finding that did not change when adjusted for comorbidities (adjusted OR: 0.94, 95% CI: 0.36-2.49). The complication rate in hospitalized patients following ablation was 8.08%. The total unadjusted complication rate was higher for females than males (9.58% vs. 7.09%, p=.001); however, it was not significant when adjusted for risks (adjusted OR: 1.23, 95% CI: 0.99-1.53, p=.06). Female sex is not associated with increased complications or death in a real-world study of catheter ablation when results are adjusted for risks. However, females admitted with atrial fibrillation receive ablation less often than males during hospital admission.

Abstract 9382: Reperfusion Delays and Outcomes Among ST-Segment-Elevation Myocardial Infarction Patients With and Without Cardiogenic Shock

Introduction: Mortality remains high among STEMI patients with cardiogenic shock (CS), and rapid reperfusion has been shown to improve outcomes. However, the comparative benefits of shorter reperfusion times among STEMI patients with and without CS is unclear. Hypothesis: STEMI patients presenting with CS would have significantly greater increases in mortality and MACE as FMC-to-device time increased compared to non-CS patients. We hoped to identify a FMC-to-device time threshold below which outcomes were optimized for CS and non-CS patients. Methods: We performed a retrospective analysis using prospective data from the Vancouver Coastal Health Authority STEMI registry. We included all patients with STEMI who received PCI between January 1, 2010, and December 31, 2020. Patients were stratified based the presence of CS at the time of admission and assessed for the primary outcome of in-hospital mortality and the secondary outcome of an in-hospital major adverse cardiovascular event (MACE), defined as a composite of the first occurrence of mortality, cardiac arrest, heart failure, ICH/CVA/Stroke or reinfarction. Logistic regression was used to estimate the relationships between FMC-to-device time and the primary and secondary outcomes in the CS and non-CS groups. Results: 2929 consecutive STEMI patients were included, of whom 9.4% (n= 275) had CS. Median FMC-to-device time was 113.5 (IQR 93.0-145.0) minutes for CS patients and 103.0 (IQR 85.0- 130.0) minutes for non-CS patients. CS patients were more likely to have FMC-to-device times above guideline recommendations (76.6% vs. 54.1%, p &lt;0.001) compared to non-CS patients. Between 60 and 90 minutes, for each 10-minute increase in FMC-to-device time, mortality for STEMI patients with CS increased by 5-8%, while for non-CS patients it increased by less than 0.5%. Compared to non-CS patients, those with CS had higher incidences of mortality (41.1% vs. 1.9%, p &lt;0.001) and MACE (81.1% vs. 19.4%, p &lt;0.001). Conclusions: Among STEMI patients undergoing primary PCI, reperfusion delays among CS patients are associated with significantly worse outcomes compared to non-CS patients. Strategies to reduce FMC-to-device times for STEMI patients specifically presenting with CS are needed.

Abstract 9444: Differences in Hospital Outcomes Following Watchman's Procedure Based on CHA 2 DS 2 VASc Score: Insight From National Inpatient Sample Database, 2016-2019

Background: Uncertainty exists whether a higher CHA 2 DS 2 VASc risk score is associated with poorer in-hospital outcomes than a lower risk score following Left Atrial Appendage Occlusion (LAAO) procedures. Methods: The National Inpatient Sample (NIS) was queried for all hospitalizations with primary atrial fibrillation or flutter from 2016 to 2019 with codes for percutaneous left atrial appendage occlusion device placement. Cohorts with high (CHA 2 DS 2 VASc ≥5) and low (CHA 2 DS 2 VASc &lt;5) risk of stroke were compared. Weighted multivariable logistic regression was used to assess the association between CHA 2 DS 2 VASc score and in-hospital outcomes. Results: Out of 60,350 procedures performed, 50.61% had high CHA 2 DS 2 VASc score ( &gt; 5) and 49.39% had low score (&lt; 5) (table 1). All patients received the Watchman device. The primary outcome of in-hospital mortality was not statistically different between high and low risk (0.18% vs. 0.12%, OR: 1.53, 95% CI: 0.59-3.96, p=0.37), a finding that did not change when adjusted for comorbidities in multivariate analysis (adjusted OR: 1.44, 95% CI: 0.55-3.62, p=0.46). In the high-risk group, total complication rates were similar (adjusted OR: 1.16, 95% CI: 0.97-1.38, p=0.09) as was ischemic stroke (adjusted OR: 2.05, 95% CI: 0.82-5.13, p=0.13) while systemic embolism (adjusted OR: 5.09, 95% CI: 1.08-23.99, p=0.04) and major bleeding requiring transfusion (adjusted OR: 3.84, 95% CI: 1.41-10.42, p=0.08) were higher after adjusting for confounders in multivariable analysis (figure 1). Conclusion: This study demonstrates that the LAAO procedure had similar short-term outcomes between high and low-risk patients in a study of real-world patients.

Abstract 15703: Outcomes of Non-ST Segment Myocardial Infarction in Patients With Heart Failure and End Stage Renal Disease

Introduction: Non-ST Segment Myocardial Infarction (NSTEMI) occurs frequently in patients with pre-existing Heart Failure (HF) and End Stage Renal Disease (ESRD). However, outcomes with invasive approaches such as percutaneous coronary intervention (PCI) or medical management remain uncertain. Hypothesis: Given severe comorbidity burden, patients with HF and ESRD admitted for NSTEMI may experience higher in-hospital mortality with an invasive strategy of PCI. Methods: We utilized the National Inpatient Sample to capture hospitalizations in the United States from 2006-2014. Admissions for NSTEMI were identified by the International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) code 401.7x. The sample was further narrowed by coexisting diagnoses of HF (ICD-9-CM: 428.xx) and ESRD (ICD-9-CM 585.6). The cohort was divided into those that received PCI or medical management only. Multivariable logistic regression was used to compare the primary outcome of in-hospital mortality between invasive and medical management only groups. Results: During the study period, 14,333 hospitalizations were identified for NSTEMI in patients with coexisting HF and ESRD. Within this cohort, 3,549 (25%) underwent PCI (age: 66±11 years,42% female) and 10,784 (75%) were managed with medications (age: 69±12 years, 45% female) only. In-hospital mortality was 5% in the PCI group in comparison to 10% in those managed with medications only (p&lt;0.01). After adjustment for clinical covariates including age, sex and diabetes mellitus, PCI was associated with lower odds of death during hospitalization (aOR: 0.52, 95% CI: 0.44-0.61, p&lt;0.01). Conclusions: Patients with HF and ESRD admitted for NSTEMI do not incur greater in-hospital mortality with PCI, despite a high burden of comorbidities. Invasive percutaneous revascularization may be reasonable for appropriately selected patients with HF and ESRD.

Abstract 9455: Sex Differences in Atrial Fibrillation Ablation Outcomes From the National Inpatient Sample Database 2016-2019

Background: Research has shown mixed results when comparing in-hospital complications following atrial fibrillation ablation in women compared to men. Objectives: To better quantify sex differences and in-hospital outcomes in atrial fibrillation ablation procedures and identify factors associated with poorer outcomes. Methods: We queried the NIS database from 2016-2019 for hospitalizations with a primary diagnosis of atrial fibrillation ablation and excluded patients with any other arrhythmias, ICD/pacemaker placement. We assessed demographics, in-hospital mortality, and complications of women compared to men. Outcomes were adjusted for potential confounders using multivariable logistic regression analysis (Figure 1). Results: Admissions for atrial fibrillation were more common in females than males (849,050 versus 815,665; p&lt;0.001). However, females were less likely to receive ablation (1.65% versus 2.71%, OR: 0.60; 95% confidence interval: 0.57-0.64, p&lt;0.001) which persisted after adjusting for cardiomyopathy (adjusted OR: 0.61; 95% confidence interval: 0.58-0.65, p&lt;0.001). The primary outcome of in-hospital mortality was not statistically different in univariate analysis (0.39% vs. 0.36%, OR: 1.09, 95% CI: 0.44-2.72, p=0.84), finding that did not change when adjusted for comorbidities (adjusted OR: 0.94, 95% CI: 0.36-2.49) (Figure 1). The total unadjusted complication rate was higher for females than males (9.58% vs. 7.09%, p=0.001); however, it was not significant when adjusted for risks (adjusted OR: 1.23, 95% CI: 0.99-1.53, p=0.06) (Figure 1). Conclusion: Female sex is not associated with increased complications or death in a real-world study of catheter ablation when results are adjusted for risks. However, females admitted with atrial fibrillation receive ablation less often than males during hospital admission. More study is needed regarding to identify factors contribute to later referral for females for catheter ablation.

Venovenous extracorporeal membrane oxygenation support in patients with COVID-19 respiratory failure: A multicenter study

ObjectiveThe COVID-19 pandemic presents a high mortality rate amongst patients who develop severe acute respiratory distress syndrome (ARDS). The purpose of this study was to evaluate the outcomes of venovenous extracorporeal membrane oxygenation (VV-ECMO) in COVID–19-related ARDS and identify the patients who benefit the most from this procedure. MethodsAdult patients with COVID-19 and severe ARDS requiring VV-ECMO support at 4 academic institutions between March and October 2020 were included. Data were collected through retrospective chart reviews. Bivariate and multivariable analyses were performed with the primary outcome of in-hospital mortality. ResultsFifty-one consecutive patients underwent VV-ECMO with a mean age of 50.4 years; 64.7% were men. Survival to hospital discharge was 62.8%. Median intensive care unit and hospitalization duration were 27.4 days (interquartile range [IQR], 17-37 days) and 34.5 days (IQR, 23-43 days), respectively. Survivors and nonsurvivors had a median ECMO cannulation time of 11 days (IQR, 8-18) and 17 days (IQR, 12-25 days). The average postdecannulation length of stay was 17.5 days (IQR, 12.4-25 days) for survivors and 0 days for nonsurvivors (IQR, 0-6 days). Only 1 nonsurvivor was able to be decannulated. Clinical characteristics associated with mortality between nonsurviors and survivors included increasing age (P = .0048), hemorrhagic stroke (P = .0014), and postoperative dialysis (P = .0013) were associated with mortality in a bivariate model and retained statistical significance in a multivariable model. ConclusionsThis multicenter study confirms the effectiveness of VV-ECMO in selected critically ill patients with COVID–19-related severe ARDS. The survival of these patients is comparable to non-COVID–19-related ARDS.

Genesis of Antibiotic Resistance (AR) LXXXI: Turbulence Modeling of Simplified Severe Sepsis Protocol‐2 (SSSP‐2), NCT01663701: ERP Induced Fluid Volume Expansion Confer Transition from Laminar to Turbulence by Discontinuity

NCT01663701(PMID:28973227) observed that a primary outcome of in‐hospital mortality (ihm) occurred in 51 of 106 patients (48.1%) in the sepsis protocol group vs 34 of 103 patients (33.0%) in the usual care group while the vital status after hospital discharge at day 28 reported for 97 patients in each study group; 28‐day mortality was 67.0% with the sepsis protocol vs 45.3% with usual care. Hypothesis: Based on the data on risk of ihm by subgroup for patients treated with the sepsis protocol vs usual care (Fig3), compared to elements of sepsis resuscitation (Table 2), and baseline characteristics of the patients (Table 1), we hypothesize that the discontinuity in fluid volume due to ERP is the pivotal determining factor for an exacerbated mortality rate in NCT0166370. Relevance of Central Venous Pressure(CVP) or Jugular Venous Pressure (JVP) for the Determination of Fluid Overload(PMID: 23774337, PMID: 24132054):NCT01663701, p1237, Table 1: The JVP data indicate that the baseline: by proximity to the sternal angle, ≥4cm below: sepsis protocol cohort: 32.1% vs usual care: 40.8%; 1‐3cm below:sepsis protocol cohort: 28.3% vs usual care 21.4%; At the sternal angle, 20.8% vs 27.2%; ≥1 cm above: sepsis protocol 20.8% vsusual care 10.7%. Cause(s) of elevated CVP or JVP:A plausible cause would be RV failure (pulmonary edema!) due to fluid volume overload by excessive fluid administration. Geometry, Governing Eq. &amp; Analysis: The mass continuity eq: 2.17, (p14‐ISBN‐13:978‐0521598866); where V1= fluid velocity, ρ1= fluid density, at terminal arteriole (cross‐sectional area) = A1and tis time interval dt, prior to ERP, length dl1=V1dt mass that enters the A1in the time interval is: dm1=ρ1dV1= ρ1A1dl1=ρ1A1v1dt. After the ERP, the expanded fluid volume passing through metarteriole (cross‐sectional area) =A2and length dl2=V2dt in the time interval dt is=dm2=ρ2dV2=ρ2A2dl2=ρ2A2v2dt. As per the mass continuity equation, (flow at any given point in a closed hydraulic system will be equal to flow at any other points) an equal amount of mass that enters the area A1in the time interval dt, must pass through area A2,therefore, dm1=dm2or ρ1A1v1dt=ρ2A2v2dt.Dividing by dt, will result ρ1A1v1=ρ2A2v2for a steady flow pattern referred to as mass continuity equation for steady flow. Our simulation analysis implicates that for the ERP induced fluid volume overload fluid flow is A1v1≠A2v2 . The rationale is that, the laminar fluid flow is in streamlines with equal space but ERP induced will not be in streamline but widely spaced, ⬆viscosity, ⬆ rate of LPE aggregation and ⬇velocity, ⬆torque &amp; drag with an unknown angular momentum, on endothelial layer in terminal arteriole. Prospects: It is suggested that the total mass of expanded fluid vol. within 6 hrs, entering/exiting the terminal arteriole (Cerebral BBB) elicit CCP rupturing the pre‐capillary vessels due to an adverse pressure gradient (APG). Differential shear stress due to APG, induce temporal regulation of ARGR expression in clinical persisters in vivo w/ orw/o vasoplegia may have been the cause for an exacerbated mortality in NCT01663701.

Abstract 238: Early Or Delayed Percutaneous Coronary Intervention For Non-st-elevation Myocardial Infarction In Pneumonia: Analysis From California State Inpatient Database (2006-2011)

Objective: Evaluate the safety of performing PCI for NSTEMI within 2 days compared to 2-7 days in patients admitted with pneumonia. Background: The gold standard for detecting coronary atherosclerotic plaque in NSTEMI continues to be PCI. The need for providing lifesaving procedures such as stent placement for NSTEMI in patients admitted with pneumonia early, within 2 days, has not been evaluated. Methods: We performed a retrospective analysis using California State Inpatient Database from years 2006-2011 to identify patients with a diagnosis of pneumonia present on admission (ICD-9-CM code 480-487) and a secondary diagnosis of NSTEMI (ICD-9-CM code 410.7) using the International Classification of Diseases, 9th edition codes. We compared the primary outcome of in-hospital mortality for patients that received PCI within 2 days of admission (early group) to those who received it between 2-7 days of admission (late group). We used a multivariable logistic regression model and adjusted for demographical characteristics, co-morbidities and severity of disease as identified by different organ failures. We also added propensity score to identify the probability that a patient would receive early PCI to the above model to increase its robustness. Results: Between 2006-2011, we identified 4980 patients in the database who were admitted with pneumonia and developed NSTEMI who underwent PCI within 7 days. A total of 1809 patients underwent PCI in early group and 3171 underwent PCI in late group. In-hospital mortality was significantly higher in early PCI group (6.5% vs 4.1%, p &amp;lt; 0.001) when compared to late PCI. Of those who underwent PCI, 1142 (36%) received stents in early group while only 518 (28.6%) received stent in late group (p &amp;lt; 0.001). Propensity adjusted multiple logistic regression analysis showed higher odds of death in early group when compared to late group (OR 1.70, 95%CI 1.26-2.29, p &amp;lt; 0.001). Conclusions: Patients admitted with pneumonia undergoing PCI within 48 hours for NSTEMI had higher mortality in comparison to those patients that underwent PCI within 2-7 days. Timing for PCI should be delayed beyond the first 48 hours in order to reduce the risk for complications and mortality in this patient population.

Outcomes, Temporal Trends, And Resource Utilization In Ischemic Vs Non-ischemic Cardiogenic Shock

<h3>Background</h3> Cardiogenic shock (CS) is associated with significant morbidity and mortality. Differentiating the etiologic factors driving CS has epidemiological significance and aids in optimization of therapeutic strategies, prognostication and resource utilization. The aim herein is to investigate the epidemiology and clinical outcomes of cardiogenic shock in those with ischemic and non-ischemic CS etiologies. <h3>Methods</h3> : Using International Classification of Diseases (ICD) codes, we queried the National Inpatient Sample for cardiogenic shock hospitalization from 2007 to 2018 and divided the study sample into cohorts of ischemic (I-CS) and nonischemic cardiogenic shock. (NI-CS). We then compared the primary outcome of in-hospital mortality between these two cohorts. Two groups of secondary outcomes (clinical and procedural) were also assessed between the two cohorts. <h3>Results</h3> : CS was present in 557,860 hospitalizations; 84% of these were I-CS and 15.8% NI-CS. Patients with I-CS were older, more commonly males, with more risk factors for coronary artery disease (p<0.05). NI-CS had higher prevalence of pre-existing systolic heart failure and atrial fibrillation. The in-hospital mortality was significantly higher in patients with I-CS (32.2% vs 29.5%, adjOR 1.10, p<0.001). Frequencies of acute ischemic stroke, mechanical ventilation, ventricular arrhythmias, and vascular complications were higher in I-CS vs NI-CS, while AKI and acute liver failure were more common in NI-CS (p<0.05). The use of mechanical circulatory support devices was higher in the I-CS group. <h3>Conclusions</h3> : Patients with I-CS comprise the vast majority of CS, and are associated with higher mortality and higher resource utilization. Conversely, patients with NI-CS appear to have higher survival but with a higher prevalence of end-organ dysfunction.

Body mass index and its association with COVID-19 clinical outcomes: Findings from the Philippine CORONA study.

Background and aimsTo explore the association between body mass index (BMI) and adverse outcomes in a large cohort of patients with coronavirus disease 2019 (COVID-19).MethodsThis is a secondary analysis of a 37-site, nationwide, multicenter, retrospective cohort study that investigated the clinical and neurological outcomes of adult patients with confirmed COVID-19 admitted from February to December 15, 2020.ResultsWe analyzed 4,463 patients with BMI and outcome data. A total of 790 (17.7%) and 710 (15.9%) had the primary outcome of in-hospital mortality and need for invasive mechanical ventilation (IMV), respectively. There was no significant association between WHO BMI groups and these outcomes. Using Asia-Pacific cutoffs showed a significant association between obesity and in-hospital mortality risk (P = 0.012). Being underweight was an independent predictor of prolonged IMV requirement regardless of BMI criteria used (P < 0.01). Obesity correlated with the need for intensive care unit admission using Asia-Pacific cutoffs (P = 0.029). There was a significant association between any BMI abnormality and odds of severe/critical COVID-19 (P < 0.05). Obese patients with concomitant acute neurological presentation/diagnosis during their COVID-19 admission were shown to have lower odds of neurologic recovery (P < 0.05).ConclusionsWe found BMI abnormalities to be associated with several adverse clinical and neurologic outcomes, although such associations may be more evident with the use of race-specific BMI criteria.

513 Fluid Over-Resuscitation in Burn Patients After Initial 24-Hours of Care is Associated with Increased Mortality

IntroductionFluid resuscitation is a cornerstone of modern burn care. Despite the use of well-established formulae to determine the appropriate amount of fluid resuscitation for the first 24 hours of care, there is increasing recognition that patients receive fluids in excess of predicted volumes, a phenomenon termed fluid creep. Underscoring the significance of this phenomenon is the association between large volumes of fluid resuscitation and adverse outcomes. Although research in non-burn ICU patients reveals a clear association between overall fluid intake and increased morbidity, minimal burn-related literature exists regarding fluid patterns after the initial 24-hour period and their impact on outcomes. We hypothesized that increased fluid administration after the standard initial resuscitation period is associated with increased morbidity and mortality.MethodsA retrospective chart review was performed for 113 patients with ≥20% TBSA burns admitted to an American Burn Association-verified burn center between 2010 and 2020. Patients admitted with Stevens-Johnson Syndrome and/or Toxic Epidermal Necrolysis, with length of stay ≤ 72 hours, who required renal replacement therapy (RRT) within 72 hours of admission, and those with withdrawal of care ≤ 7 days of admission were excluded. Univariate and multivariate logistic regression was used to determine the association between the primary outcome of in-hospital mortality and secondary outcomes of increased ventilator days, acute kidney injury, need for RRT, and hospital length of stay, with increasing total and net fluid volumes from days 2 through 7 of treatment. Additionally, the association between first OR day and total fluid volumes in the first week were assessed.ResultsMedian age was 41 years (IQR 23-55) and TBSA was 31% (IQR 24-43). 21 patients (18.6%) died during hospitalization. Increase in net fluid balance from days 2-7 were associated with increased mortality (OR 1.016, 95% CI 1.00 – 1.03, p = 0.013). Increasing total fluid volumes were significantly associated with increased ventilator days (OR 1.027, 95% CI 1.008-1.047, p = 0.006) and acute kidney injury (OR 1.003, 95% CI 1.000-1.006, p = 0.017). Early first OR day was associated with decreased net fluid balance between hospital days 2-7 (OR 0.993, 95% CI 0.989-0.997, p = 0.001).ConclusionsSimilar to studies on other ICU populations, increasing total fluid volumes and net fluid balance is associated with adverse outcomes in critically ill burn patients. Additionally, earlier initial OR is associated with less total fluid volumes and lower net fluid balance in the first week of hospitalization. Further investigation is needed to elucidate optimal markers of resuscitation in burn patients in an effort to decrease adverse fluid administration.