Risk Factors For Early Death Research Articles

A predictive model for early death in elderly patients with gastric cancer: A population-based study

BackgroundThe mean age of gastric cancer (GC) patients has increased due to the aging society. Elderly GC patients with poor physical status tend to develop complications during the treatment courses, which cause early death. This study aimed to identify risk factors and establish nomograms for predicting total early death and cancer-specific early death in elderly GC patients.MethodsData for elderly GC patients were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. These patients were randomly assigned to a training cohort and a validation cohort. The univariate logistic regression model and backward stepwise logistic regression model were used to identify independent risk factors for early death. Nomograms were constructed to predict the overall risk of early death and their performance was validated by receiver operating characteristic (ROC) curve, calibration curve, decision curve analyses (DCA), integrated discrimination improvement (IDI), and net reclassification improvement (NRI) in both training and validation cohorts.ResultsAmong the 3102 enrolled patients, 1114 patients died within three months from the first diagnosis and 956 of them died due to cancer-specific causes. Non-Asian or Pacific Islander (API) race, non-cardia/fundus or lesser/greater curvature, higher AJCC stage, no surgery and no chemotherapy were all related to a high risk of both all-cause early death and cancer-specific early death. Higher T stage and N0 stage were only positively related to total early mortality, while liver metastasis was only positively related to cancer-specific early mortality. Based on these identified factors, two nomograms were developed for predicting the risk of all-cause and cancer-specific early death, which showed good performance with the AUC of the nomograms were 0.775 and 0.766, respectively. The calibration curves, DCAs, NRI, and IDI also confirmed the value of these nomograms.ConclusionsThese nomogram models were considered a practical tool to identify the early death of elderly GC patients and help provide a more individualized treatment strategy.

Risk factors for early death or euthanasia within 100 days of diagnosis in dogs with meningoencephalitis of unknown origin

Meningoencephalitis of unknown origin (MUO) in the dog is an inflammatory condition of the central nervous system with variable short- and long-term prognosis. Previous studies have attempted to identify risk factors for early death; however, the findings were inconsistent and prognostication and treatment selection remain difficult for cases of MUO. The aim of this study was to compare the influence of putative prognostic factors on early survival in dogs with MUO. Logistic regression was used to analyse the effect of clinical and magnetic resonance imaging (MRI) features at diagnosis and type of immune-suppressive treatment received on survival at three-time points; 7 days, 30 days, and 100 days post-diagnosis. Ninety eight dogs were included.Dogs that were obtunded at presentation had a 6.6 times increased odds of death in the first 7 days after diagnosis, a 2.1 times increased risk of death 8–30 days after diagnosis, and a 1.9 times increased risk of death 31–100 days after diagnosis. No other clinical, MRI feature, or treatment was found to have a significant influence on survival. Obtundation at presentation was found to increase risk of early euthanasia in dogs with MUO, while the addition of an IV infusion of cytarabine to immune-suppressive corticosteroid therapy (prednisolone and/or dexamethasone) at initial treatment did not improve the odds of survival at 7, 30, or 100 days after diagnosis.

Early mortality factors in immune checkpoint inhibitor monotherapy for advanced or metastatic non-small cell lung cancer

PurposeImmune checkpoint inhibitors (ICI) are a promising treatment, but may cause hyperprogressive disease and early death. The present study investigated early mortality factors in ICI monotherapy for lung cancer.Patients and methodsWe retrospectively reviewed all patients diagnosed with advanced or metastatic non-small cell lung cancer (NSCLC) and treated with ICI monotherapy (nivolumab, pembrolizumab, and atezolizumab) between March 2016 and August 2021 at National Hospital Organization Kochi Hospital and Tokushima University. Early death was defined as patients who died within 60 days of ICI treatment.ResultsA total of 166 patients were included. The majority of patients (87%) had an Eastern cooperative oncology group (ECOG) Performance status (PS) of 0/1. There were 21 early deaths. Significant differences were observed in ECOG PS, the histological type, liver metastasis, tumor size, the white blood cell count, neutrophils (%), lymphocytes (%), the neutrophil-to-lymphocyte ratio in serum (sNLR), C-reactive protein (CRP), and albumin between the groups with or without early death. Univariate logistic regression analyses identified ECOG PS score ≥ 2, liver metastasis, tumor size ≥ 5 cm, neutrophils ≥ 69%, lymphocytes < 22%, sNLR ≥ 4, CRP ≥ 1 mg/dl, and albumin < 3.58 g/dl as significant risk factors for early death. A multivariate logistic regression analysis revealed that liver metastasis (Odds ratio [OR], 10.3; p = 0.008), ECOG PS score ≥ 2 (OR, 8.0; p = 0.007), and a smoking history (OR, 0.1; p = 0.03) were significant risk factors for early death.ConclusionLiver metastases, ECOG PS score ≥ 2, and a non-smoking history are early mortality factors in ICI monotherapy for advanced or metastatic NSCLC.

Risk factors and predictive nomograms for early death of patients with advanced hepatocellular carcinoma: a large retrospective study based on the SEER database

BackgroundHepatocellular carcinoma (HCC) is a kind of tumor with high invasiveness, and patients with advanced HCC have a higher risk of early death. The aim of the present study was to identify the risk factors of early death in patients with advanced HCC and establish predictive nomograms.MethodsDeath that occurred within 3 months of initial diagnosis is defined as early death. Patients diagnosed with stage IV HCC between 2010 and 2015 were collected from the Surveillance, Epidemiology, and End Results database for model establishment and verification. Univariable and multivariable logistic regression analyses were used to identify the risk factors. Predictive nomograms were constructed and an internal validation was performed. Decision curve analysis (DCA) was used to verify the true clinical application value of the models.ResultsOf 6603 patients (57% age > 60, 81% male, 70% white, 46% married), 21% and 79% had stage IVA and IVB, respectively. On the multivariable analyses, risk factors for early deaths in patients with stage IVA were age, tumor size, histological grade, alpha-fetoprotein (AFP), fibrosis score, tumor stage (T stage), surgery, radiotherapy, and chemotherapy, and that in stage IVB were age, histological grade, AFP, T stage, node stage (N stage), bone metastasis, lung metastasis, surgery, radiotherapy, and chemotherapy. The areas under the curves (AUCs) were 0.830 (95% CI 0.809–0.851) and 0.789 (95% CI 0.768–0.810) in stage IVA and IVB, respectively. Nomograms comprising risk factors with the concordance indexes (C-indexes) were 0.820 (95% CI 0.799–0.841) in stage IVA and 0.785 (95% CI 0.764–0.0.806) in stage IVB for internal validation (Bootstrapping, 1000re-samplings). The calibration plots of the nomograms show that the predicted early death was consistent with the actual value. The results of the DCA analysis show that the nomograms had a good clinical application.ConclusionThe nomograms can be beneficial for clinicians in identifying the risk factors for early death of patients with advanced HCC and predicting the probability of early death, so as to allow for individualized treatment plans to be accurately selected.

The nomograms to predict early death among metastatic small-cell lung cancer patients: a retrospective study based on SEER database.

BackgroundThis study aims to discriminate risk factors associated with early death (died within 3 months) in metastatic small-cell lung cancer (SCLC) patients, and construct predictive nomograms to help physicians in guiding individual treatment.MethodsSurveillance, Epidemiology, and End Results (SEER) database was used to obtain records of deceased metastatic SCLC patients. The univariate and multivariate logistic regression methods were managed to identify risk factors for early death in overall patients and chemotherapy recipients. Predictive nomograms were developed and then validated by receiver operating characteristics curve (ROC) and calibration plots to verify its’ precision.ResultsA total of 13,229 patients were collected of which 5,832 of them encountered early death. The univariate and multivariate logistic regression analysis identified variables that were negatively associated with early death include sex, age, race, sequence, T stage, N stage, organ metastasis. Chemotherapy and radiotherapy implementation significantly decreased the odds of early death. For the chemotherapy recipients, white male patients with advanced age (over 80 years old), T4 stage, multiple organ metastasis, and without radiotherapy most likely died within 3 months. The area under the curve (AUC) of the nomograms for overall population and chemotherapy recipients’ early death prediction was 0.839 and 0.653.ConclusionsEarly death among metastatic SCLC patients was extremely common in clinical practice. The nomograms constructed were able to assist clinical physicians in discriminating high-risk SCLC patients for targeted intervention, and elderly white male patients diagnosed with advanced T stage and multiple organ metastasis might be exempted from systemic treatment to receive palliative care.

Mid-Term Outcomes of Primary Arterial Switch Operation for Taussig-Bing Anomaly

To identify risk factors associated with mortality and reintervention on primary arterial switch operation for Taussig-Bing anomaly in 225 cases over a 16-year period. From 2002 to 2017, 225 children with Taussig-Bing anomaly received a primary arterial switch operation at the Shanghai Children's Medical Center. Perioperative data and follow-up results were collected. Univariate and multivariable analysis was used to explore risk factors associated with early mortality. The competing risk analysis was used to identify risk factors related to reintervention. Early mortality was 12.9% (29/225) with a satisfactory long-term survival rate (10-year survival rate 85.0%). The median age at repair was 77 days (interquartile range, IQR, 48-139). The median duration of follow-up was 4.6 (range 0.1-18.3) years. 87 children (38.7%) received concomitant aortic arch repair. Prolonged cardiopulmonary bypass time (a-OR 1.18, 95% confidence interval [CI], 1.09-1.28, p < 0.001) is found to be an independent risk factor for early death. Larger weight at repair tends to be a protective factor (a-OR 0.66, 95% CI, 0.425-1.02, p=0.060) and intramural coronary artery (a-OR 4.81, 95% CI, 0.927-24.9, p=0.062) tends to be a risk factor for early mortality. The cumulative incidence rate of overall reintervention was 18.9% (95% CI, 10.3%-27.4%) at 5 years and 32.3% (95% CI, 17,0%-47.6%) at 10 years. No independent risk factors were identified for long-term overall reintervention. Prolonged aortic-cross clamp time was an independent risk factor for long-term right-sided reintervention (adjusted hazard ratio [a-HR] 1.12, 95% CI 1.005-1.25, p=0.041). Neo-aortic regurgitation was a concern with an incidence rate of moderate or greater neo-AR of 16.1 % (95% CI 7.6%-24.7%) at 10 years. Intramural coronary artery remains a surgical challenge in primary arterial switch operation for the Taussig-Bing anomaly. Larger weight at ASO tends to be a protective factor for early death. Reintervention is frequently necessary but can be performed with satisfactory results.

Underage drinking in Brazil: findings from a community household survey.

Objectives:Previous studies have estimated the 30-day prevalence of alcohol use to be approximately 21% among youth in Brazil, despite the legal drinking age of 18 years. The present study aimed to determine the prevalence of underage drinking and its associated factors among adolescents in Brazil.Methods:The 3rd National Survey on Drug Use by the Brazilian Population (III Levantamento Nacional sobre o Uso de Drogas pela População Brasileira) is a nationwide, multi-stage, probability-sample household survey. Herein, youth between the ages of 12-17 years were included. Lifetime and 12-month alcohol use prevalence were estimated. Factors associated with 12-month alcohol use were evaluated through multivariate analysis considering survey weights and design.Results:Overall, 628 youth were interviewed. Estimated lifetime and 12-month alcohol use were 34.3% (standard error [SE] = 1.9) and 22.2% (SE = 1.7), respectively. Factors associated with 12-month drinking were: other/no religion vs. Christianity; living in rural vs. urban areas; self-reported diagnosis of depression vs. no self-reported depression; lifetime tobacco use vs. no history of tobacco use; and any illicit drug use vs. no history of illicit drug use.Conclusion:Considering that alcohol use is a major risk factor for early death among Brazilian youth, our findings highlight the importance of preventative measures to reduce underage drinking.

Prognostic Factors of Early Death in Childhood Hemophagocytic Lymphohistiocytosis: Experience From A Single Tertiary Center in Thailand

Objective: To establish the clinical profile, outcomes, and risk factors of mortality in pediatric hemophagocytic lymphohistiocytosis (HLH) patients admitted to a tertiary care hospital in the south of Thailand.Material and Methods: The medical records of HLH patients aged under 15 years were retrospectively reviewed. Survival times were estimated using the Kaplan-Meier estimator. Univariate associations between covariates and survival were visualized with graphs and compared using the log-rank test. Factors with statistical significance in the univariate analysis were included in a multivariate cox regression analysis.Results: A total of 24 childhood HLH cases were identified over the 20-year study period. Central nervous system (CNS) involvement at diagnosis (hazard ratio [HR]: 7.7, 95% CI: 1.2-51.2), absolute neutrophil count (ANC) &lt;1,000.0 cells/μL (HR: 33.3, 95% CI: 2.7-39.8) and renal insufficiency (HR: 28.2, 95% CI: 2.1-373.8) were adverse risk factors. Forty-six percent of the children survived at least 30 days after diagnosis with a median survival time of 21 days. Conclusion: CNS involvement, low ANC and renal insufficiency at diagnosis were adverse risk factors for early death in HLH children.

Interplay between hypertriglyceridemia and acute promyelocytic leukemia mediated by the cooperation of peroxisome proliferator-activated receptor-α with the PML/RAR α fusion protein on super-enhancers.

Patients with newly diagnosed acute promyelocytic leukemia (APL) are often obese or overweight, accompanied by metabolic disorders, such as dyslipidemia. However, the link between dyslipidemia and leukemia is obscure. Here, we conducted a retrospective study containing 1,412 cases (319 newly diagnosed APL patients, 393 newly diagnosed non-APL acute myeloid leukemia patients, and 700 non-tumor controls) and found that APL patients had higher triglyceride levels than non- APL and control groups. Using clinical data, we revealed that hypertriglyceridemia served as a risk factor for early death in APL patients, and there was a positive correlation between triglyceride levels and leukocyte counts. RNA sequencing analysis of APL patients having high or normal triglyceride levels highlighted the contribution of peroxisome proliferatoractivated receptor-α (PPARα), a crucial regulator of cell metabolism and a transcription factor involved in cancer development. The genome-wide chromatin occupancy of PPARα revealed that PPARα co-existed with PML/RARα within the super-enhancer regions to promote cell proliferation. PPARα knockdown affected the expression of target genes responsible for APL proliferation, including FLT3, and functionally inhibited the proliferation of APL cells. Moreover, in vivo results in mice having high fat diet-induced high triglyceride levels supported the connection between high triglyceride levels and the leukemic burden, as well as the involvement of PPARα-mediated-FLT3 activation in the proliferation of APL cells. Our findings shed light on the association between APL proliferation and high triglyceride levels and provide a genetic link to PPARα-mediated hyperlipidemia in APL.

Partial upper sternotomy for extensive arch repair in older acute type A aortic dissection patients

ObjectivesThe partial upper sternotomy (PUS) approach is acceptable for aortic valve replacement, and even aortic root operation. However, the efficiency of PUS for extensive arch repair of acute type A aortic dissection (AAAD) in older adult patients has not been well investigated.MethodsBetween January 2014 and December 2019, 222 older adult patients (≥ 65 years) diagnosed with AAAD went through extensive arch repair, among which 127 received PUS, and 95 underwent full sternotomy (FS). Logistic regression analysis was used to identify risk factors for early death, and negative binomial regression analysis was applied to explore risk factors related to post-operative ventilator-supporting time and intensive care unit stay time.ResultsTotal early mortality was 8.1% (18/222 patients). The PUS group had shorter Cardiopulmonary bypass time (133.0 vs.155.0 min, P < 0.001), cross-clamp time (44.0 vs. 61.0 min, P < 0.001) and shorter selective cerebral perfusion time (11.0 vs. 21.0 min, P < 0.001) than the FS group. Left ventricle ejection fraction < 50% (odds ratio [OR] 17.05; 95% confidence interval [CI] 1.87–155.63; P = 0.012) and malperfusion syndromes (OR 65.83; 95% CI 11.53–375.86; P < 0.001) were related to early death. In the multivariate model, the PUS approach contributed to shorter ventilator-supporting time (incidence rate ratio [IRR] 0.76; 95% CI 0.64–0.91; P = 0.003), when compared with the FS group.ConclusionsThe early results of emergency extensive arch repair of AAAD via PUS in older adult patients were satisfactory. However, the long-term results remain to be investigated.

Analysis of risk factors for early death in patients with acute promyelocytic leukaemia treated with arsenic trioxide.

To date, no specific studies have evaluated early death (ED) in patients with acute promyelocytic leukaemia (APL) homogeneously treated with arsenic trioxide induction therapy and investigated according to the white blood cell (WBC) count at onset. Such patients were retrospectively analysed in this study, including 314 patients with a WBC count ≤ 10 × 109/L (standard-risk (SR) group) and 144 with a WBC count > 10 × 109/L (high-risk (HR) group). The baseline clinical characteristics and risk factors for ED were compared between the two groups. The incidence of fibrinogen < 1.0g/L and elevated serum uric acid, aspartate aminotransferase and creatinine levels were higher in the HR group than in the SR group (P = 0.001; P < 0.001; P < 0.001; P = 0.044, respectively). The ED rate was significantly higher in the HR group than in the SR group (29.17% vs. 10.83%, P < 0.001). The main cause of ED was bleeding, followed by infection and differentiation syndrome (DS) in the HR group, while it was bleeding, followed by DS and infection in the SR group. Male sex, age > 50years old, and fibrinogen < 1.0g/L were independent risk factors for ED in the SR group. Increased serum creatinine levels, decreased albumin levels, and fibrinogen < 1.0g/L were independent risk factors for ED in the HR group. Overall, the incidence of ED was higher in the HR group, and the baseline clinical characteristics, causes, times, and predictors of ED in the HR group differed from those in the SR group.

Prognostički faktori rizika za ranu smrt kod bolesnika sa akutnom mijeloidnom leukemijom

Introduction: Early death is a known complication in the treatment of patients suffering from acute myeloid leukemia (AML). It has been defined as death occurring within 28 days of the initiation of induction chemotherapy. Aim: Determining the clinical characteristics of the patient, the risk factors, the frequency, and the most common causes of early death in AML patients. Materials and methods: This retrospective study included 248 patients with diagnosed AML. At diagnosis, the following demographic and clinical-laboratory characteristics were recorded: sex, age, general functional status, i.e., performance status according to the ECOG scale, complete blood count, LDH level in the blood, percentage of blasts in peripheral blood and bone marrow, fibrinogen, PT, aPTT, D-dimer, and BMI. Patients were treated with induction and reduction chemotherapy and palliative therapy. Statistical analysis was performed using the data from the discharge summaries taken from the registers of the Clinic for Hematology of the Clinical Center of Serbia. Results: Early death occurred in 53 (21.4%) patients. The prognostic risk factors for early death were the following: age (p = 0.047), ECOG ≥ 2 (p = 0.001), leukocyte count ≥ 30 x 109 /l (p = 0.022), LDH level ≥ 450 U/l (p = 0.022), the percentage of blasts in peripheral blood (p = 0.005) and the percentage of blasts in bone marrow (p = 0.003), PT (p &lt; 0.001), as well as the ISTH score (p = 0.018). The most common cause of early death in patients aged 40 - 65 years was sepsis, while in patients older than 65 years it was respiratory failure. Conclusion: The study showed that age, the leukocyte count, the percentage of peripheral blood and bone marrow blasts, the ECOG score, LDH, PT, and the ISTH score were significant prognostic risk factors of early death in patients with AML, and that the most common cause of early death in patients aged 40 - 65 years was sepsis, while in patients older than 65 years it was respiratory failure.

Risk factors for early death in urgent-start peritoneal dialysis patients: A multicenter retrospective cohort study.

Assess risk factors for early death in patients who underwent urgent-start peritoneal dialysis (USPD). Patients who initiated USPD in five peritoneal dialysis centers from 2013 to 2019 were screened in this multicenter retrospective cohort study. Risk factors for all-cause mortality within 3 months were explored. A total of 1265 USPD patients with 43 early deaths were included. Cox regression analyses showed that age older than 60 years (hazard ratio [HR], 3.054; 95% CI [1.597, 5.842]; p=0.001), albumin less than 30 g/L (HR, 2.234; 95%CI [1.207, 4.136]; p=0.011), blood glucose greater than 7 mmol/L (HR, 2.766; 95%CI [1.477, 5.180]; p=0.001), higher estimated glomerular filtration rate (eGFR; HR, 1.121; 95%CI [1.071, 1.172]; p=0.000), and poor stages of heart failure (class IV compared with class 0-I; HR, 5.165; 95%CI [2.544, 10.486]; p=0.000) were independent predicting factors for early death. Risk factors for early death were older age, hypoproteinemia, hyperglycemia, higher eGFR, and severe heart failure.

Mortality Risk within 14 Days after Coronavirus Disease 2019 Diagnosis in Dementia Patients: A Nationwide Analysis

Introduction: The study evaluated the increased mortality risk within 14 days of coronavirus disease 2019 (COVID-19) diagnosis in dementia patients. Methods: This retrospective study was conducted from February to April 2020 using the COVID-19 patients’ database from the Korea Disease Control and Prevention Agency. The risk factors for early death within 14 days were determined using generalized logistic regression performed in a stepwise manner. Dementia patients diagnosed with COVID-19 were used for the study. The propensity score-matched cohort was included as controls. The differences in mortality within 14 days after COVID-19 diagnosis between the dementia patients and controls were evaluated. Results: We enrolled 5,349 COVID-19 patients from the database; 224 had dementia as comorbidity. The mortality rate within 14 days after COVID-19 diagnosis in dementia patients and the controls was 23.7% versus 1.7%, respectively, before propensity score matching (PSM) (p < 0.001), and 23.7% versus 9.2% after PSM (p < 0.001). The hazard ratio (HR) for mortality within 14 days in COVID-19 patients with dementia was significant even after PSM (HR 5.104, 95% confidence interval 2.889–5.673, p < 0.001). The survival curve of dementia patients was steeply inclined within 14 days after COVID-19 diagnosis, resulting in 70.7% of all deaths in dementia patients. Conclusions: COVID-19 patients with dementia had a higher risk of early death within 14 days. Thus, prompt intervention is necessary for dementia patients after COVID-19 diagnosis.

Early Death and Survival of Patients With Acute Promyelocytic Leukemia in ATRA Plus Arsenic Era: A Population-Based Study.

Most randomized trials for acute promyelocytic leukemia (APL) have investigated highly selected patients under idealized conditions, and the findings need to be validated in the real world. We conducted a population-based study of all APL patients in Zhejiang Province, China, with a total population of 82 million people, to assess the generalization of all-trans retinoic acid (ATRA) and arsenic as front-line treatment. The outcomes of APL patients were also analyzed. Between January 2015 and December 2019, 1,233 eligible patients were included in the final analysis. The rate of ATRA and arsenic as front-line treatment increased steadily from 66.2% in 2015 to 83.3% in 2019, with no difference among the size of the center (≥5 or <5 patients per year, p = 0.12) or age (≥60 or <60 years, p = 0.35). The early death (ED) rate, defined as death within 30 days after diagnosis, was 8.2%, and the 3-year overall survival (OS) was 87.9% in the whole patient population. Age (≥60 years) and white blood cell count (>10 × 109/L) were independent risk factors for ED and OS in the multivariate analysis. This population-based study showed that ATRA and arsenic as front-line treatment are widely used under real-world conditions and yield a low ED rate and a high survival rate, which mimic the results from clinical trials, thereby supporting the wider application of APL guidelines in the future.

Management of pertrochanteric fractures in patients over 90 years: In-hospital mortality rate, complications and associated risk factors

PurposeThis study aims primarily to investigate the outcome following surgical management of pertrochanteric fractures of patients over 90 years compared to the outcome of a control group below 90 years under special consideration of the timing of surgery. The second aim was to analyze potential risk factors for early deaths in very old patients. This study allows us to draw conclusions to minimize complications linked to this particular age segment.MethodsThe study group consisted of very old patients aged 90 years and older. Geriatric patients aged between 60 and 89 years of age were part of the control group. Type A1 pertrochanteric fractures were typically treated by dynamic hip crews, type A2 and A3 fractures by femoral nails. Full weight bearing physiotherapy was initiated on the day after surgery to improve mobility and muscle strength.ResultsA total of 71 patients belonged to the study group (mean age: 92.5 years ±2.3 years), whereas 223 patients formed the control group (mean age: 79.9 ± 7.4 years). The mortality rate and the number of detected and documented complications were significantly higher in the study group (p = 0.001; p = 0.009, respectively). Despite the significantly higher complication rate in the > 90-year-old patients, there was no significant difference in the mean length of in-hospital-stay between the both groups (> 90 yrs.: 12.1d; < 90 yrs.: 13.1 d) and the timing of surgery.ConclusionThe number of co-morbidities, number of daily-administered medications and the time between admission and surgery have no impact on the outcome. We noticed a longer period between admission and surgery in very old patients who survived. Patients with pertrochanteric fractures should be screened for multimorbidity and cognitive disorders in a standardized manner.

Risk factors for postoperative bleeding and early death in percutaneous endoscopic gastrostomy: A multicenter retrospective study.

Comprehensive reports on the risk factors for bleeding and early death after percutaneous endoscopic gastrostomy (PEG) are limited. In this multicenter study, we retrospectively investigated the risk factors for bleeding and early death after PEG. Patients (n=1234) who underwent PEG between 2015 and 2020 at Osaka Medical and Pharmaceutical University and its affiliated hospitals (11 institutions in total) were evaluated for postoperative bleeding and early death (within 60days) after PEG according to patient characteristics, construction method, medical history, medications, preoperative hematological findings, and perioperative adverse events. Multivariate logistic regression was performed to identify independent predictors of bleeding and early death after PEG. The risk factors for bleeding after PEG were PEG tube insertion using the modified introducer method (odds ratio [OR], 4.37; P=0.0003), low platelet count (OR, 0.99; P=0.014), antiplatelet therapy (OR, 2.11; P=0.036), and heparinization (OR, 4.50; P=0.007). Risk factors for early death were low body mass index (BMI) (OR, 0.89; P=0.015), low serum albumin levels (OR, 0.50; P=0.035), and comorbidity of active cancer (OR, 4.03; P<0.0001). There was no significant association between bleeding and early death after PEG. We identified several risk factors for bleeding and early death after PEG. Risk factors for bleeding were PEG tube insertion using the modified introducer method, low platelet count, antiplatelet therapy, and heparinization. Risk factors for early death were low BMI, low serum albumin levels, and comorbidity of active cancer.

Primary Graft Dysfunction After Isolated Heart Transplantation - Incidence, Risk Factors, and Clinical Implications Based on a Single-Center Experience.

Since the international consensus on primary graft dysfunction (PGD) following heart transplantation (HT) was reported in 2014, few clinical studies have been reported. We aimed to analyze the incidence, predictive factors, and clinical implications of PGD following the International Society of Heart and Lung Transplant criteria in a single center.Methods and Results:This study enrolled 570 consecutive adult patients undergoing isolated HT between November 1992 and December 2017. Under a new set of criteria, PGD-left ventricle (PGD-LV) occurred in 35 patients (6.1%; mild, n=1 [0.2%]; moderate, n=14 [2.5%]; severe, n=20 [3.5%]), whereas PGD-right ventricle (PGD-RV) occurred in 3 (0.5%). Multivariable analysis demonstrated that preoperative admission (odds ratio [OR] 4.20; 95% confidence interval [CI] 1.24-14.26; P=0.021), preoperative extracorporeal membrane oxygenation (OR 4.03; 95% CI 1.75-9.26; P=0.001), and prolonged total ischemic time (OR 1.09; 95% CI 1.02-1.15; P=0.006) were significant predictors of moderate to severe PGD-LV. Moderate to severe PGD-LV was an independent and significant risk factor for early death (OR 55.64; 95% CI 11.65-265.73; P<0.001), with its effects extending up to 3 months after HT. Moderate to severe PGD-LV, as defined by the new guidelines, is an important predictor of early mortality, with effects extending up to 3 months after HT. Efforts to reduce the occurrence of moderate to severe PGD-LV may lead to better outcomes.

Pulmonary Hypertension and Associated Risk Factors in a High Burden Sickle Cell Disease Population

▪Introduction: Chronic pulmonary complications in sickle cell disease (SCD) are major causes of morbidity and mortality, particularly among those with sickle cell anemia (SCA), and accounts for 20-30% of all sickle cell deaths (Gray et. al. J Clin Pathol 1991; Thomas et. al. BMJ 1982).These complications include abnormalities in pulmonary function, interstitial lung disease and pulmonary hypertension (PH) in its severest form. An elevated tricuspid regurgitant jet velocity (TRV) obtained via doppler echocardiography, is a validated non-invasive screening tool for possible PH and an independent risk factor for early death among patients with SCD (Gladwin et. al. N Engl J Med 2004; Mehari et. al. JAMA 2012). It has been shown that measured TRV ≥ 2.5m/s is associated with decreased survival, estimated to be 40% at 40 months (Castro et. al. Blood 2003). The prevalence of PH determined by echocardiography is between 25-30% in SCA patients (Aliyu et. al. Am J Hematol 2008).Though the burden of SCD in Sub-Saharan Africa is high, there is paucity of research into chronic lung complications, particularly pulmonary hypertension in this special population. Ghana, a West African country, has a high burden of SCD with over 16,000 babies born annually with the disease. This study therefore determined the prevalence of pulmonary hypertension and its associated risk factors.MethodsThis was a cross-sectional study involving 76 clinically stable SCA patients aged 18 years and above. A structured and pre-tested questionnaire was used to obtain socio-demographic and clinical information. The cardiopulmonary system of participants was thoroughly examined and a modified version of St George's questionnaire was used to screen and exclude those with chronic lung disease. Doppler echocardiography was used to measure TRV. The participants underwent spirometry testing, pulse oximetry measurement, and laboratory investigations including a complete blood count, free plasma hemoglobin, blood urea and creatinine.ResultsTwenty-five (32.9%) of the SCA participants had elevated TRV (≥ 2.5m/s), which was suggestive of pulmonary hypertension. Nineteen (76%) had values between 2.5m/s - 2.9m/s, representing mild pulmonary hypertension and Six (24%) had values ≥ 3.0m/s suggestive of moderate-severe pulmonary hypertension.A negative correlation between TRV and steady-state haemoglobin (Hb) was observed (R= - 0.456, p < 0.001). Those with elevated TRV had a mean Hb of 6.9g/dl compared to 8.6g/dl in those with TRV < 2.5m/s. Further analysis showed that 6 of the SCA participants with TRV ≥ 3.0m/s had a much lower mean Hb (5.8g/dl). There was also an association between TRV and blood urea level (p = 0.030), but not with serum creatinine (p < 0.088). Oxygen saturation was significantly associated with measured TRV (p < 0.001) values. The proportion of SCA with abnormal spirometry (restrictive, obstructive and mixed defects) was 70.4% but this was however not significantly associated with measured TRV values.ConclusionPulmonary hypertension occurred in about a third of the SCA participants, the presence of which was significantly associated with steady state hemoglobin, oxygen saturation and blood urea level. Early screening and identification of risk factors for PH is therefore recommended to reduce morbidity and mortality. DisclosuresNo relevant conflicts of interest to declare.

The incidence and risk factors for early death among patients with oral tongue squamous cell carcinomas.

The objective of this study is to evaluate the early mortality rate and associated factors for early death in oral tongue squamous cell carcinomas (OTSCC) patients. Patients with OTSCC were extracted from the SEER database between 2004 and 2014. The early death (survival time≤3months) rate was calculated, and associated risk factors were evaluated by the logistic regression models. A total of 7756 patients were analysed and 282 (3.6%) patients died within 3months after cancer diagnosis, among whom 214 (2.8%) patients died from cancer-specific cause. In univariate analyses, advanced age, divorced/single/widowed (DSW), higher histological grades, black, advanced T stage, advanced N stage, distant metastasis and no surgery were significantly associated with all-causes and cancer-specific early death. Multivariate analyses showed that advanced age, DSW, advanced T stage, advanced N stage, distant metastasis, and no surgery were significantly associated with all-cause and cancer-specific early death. Our results showed that a total of 3.6% patients with OTSCC suffered early death. Predictors of early death are primarily related to age older than 60years, advanced T stage, advanced N stage, distant metastasis and no surgery but also include unmarried status, but better prognostic and predictive tools in larger sample to select early death patients are needed.