Risk Factors For Early Mortality Research Articles

Age, Gender and Diabetes as Risk Factors for Early Mortality in Dialysis Patients: A Systematic Review.

Objective: To study the impact of age, gender, and presence of diabetes (any type) on the risk of early deaths (180-day mortality) in patients starting long-term hemodialysis (HD) therapy.Design: Systematic review of the literature.Setting: Out-patient (non-hospitalized), community-based HD therapy world-wide.Participants: Patients with advanced chronic kidney disease (CKD) starting long-term HD treatment for end-stage renal disease (ESRD).Methods: Medline and EMBASE were searched for studies published between 1/1/1985 and 12/31/2017. Observational studies involving adult subjects commencing HD were included. Data extracted included population characteristics and settings. In addition, patient or treatment related factors studied with reference to their relationship with the risk of early mortality were documented. The Quality in Prognosis Studies tool was used to assess risk of bias in individual studies. Findings were summarized, and a narrative account was drawn.Results: Included were 26 studies (combined population 1,098,769; representing 287,085 person-years of observation for early mortality). There were 17 cohort and 9 case-control studies. Risk of bias was low in 13 and high in a further 13 studies. Patients who died in the early period were older than those who survived. Mortality rates increased with advancing age. Female gender was associated with slightly increased early mortality rates in larger and higher quality studies. The available data showed conflicting results in relation to the association of diabetes and risk of early mortality.Conclusions: This systematic review evaluated the impact of key demographic and co-morbid factors on risk of early mortality in patients starting maintenance HD. The information could help in delivering more tailored prognostic information and planning of future interventions.

WS02.1 Cirrhosis with portal hypertension is a risk factor for early mortality in cystic fibrosis patients

WS02.1 Cirrhosis with portal hypertension is a risk factor for early mortality in cystic fibrosis patients

Risk factors of early mortality after surgical treatment for infective endocarditis.

To explore the basic clinical characteristics and relevant factors affecting the early postoperative prognosis in patients with infective endocarditis (IE). A total of 702 patients with IE, who underwent surgery in Xiangya Hospital, Central South University from January 1981 to June 2019, were studied and the data were collected through the paper records and the hospital information system. The patients from January 1981 to June 2010 served as an early group (n=224), and other patients from July 2010 to June 2019 served as a recent group (n=478). Independent risk factors for early postoperative death were determined by logistic regression analysis. The mean age of the 702 patients was 36.7±16.1 years, and the male accounted for 68.1%. Preoperative stroke occurred in 71 patients (10.1%), and dialysis was done in 14 patients (2%) preoperatively. Streptococcus were the pathogenic bacteria in 172 patients, accounting for 59.5% of all positive blood culture results. In the early group, the percentage of IE combined with congenital heart disease was significantly higher than that in the recent group [77 patients (34.4%) in the early group vs 22 patients (4.6%) in the recent group; P<0.05]. Postoperative stroke occurred in 15 patients (2.1%), while 59 patients (7%) required new dialysis postoperatively because of renal insufficiency. Twenty-nine patient died in the post-operation, with 4.1% in 30-day mortality. Logistic regression analysis revealed that the high preoperative New York Heart Association (NYHA) grade of cardiac function (OR=3.22, 95% CI 1.50-6.88; P<0.01), postoperative stroke (OR=5.75, 95% CI 1.22-27.07; P<0.05), postoperative dialysis (OR=15.53, 95% CI 3.50-68.82; P<0.01), perivalvular abscess (OR=13.19, 95% CI 3.83-45.42; P<0.01) and multivalve involvement (OR=3.57, 95% CI 1.24-10.30; P<0.05) were the independent risk factors for early mortality. Streptococcus is the most common pathogenic bacteria in the patients with IE. Surgery for IE can obtain a satisfactory early outcomes. High preoperative NYHA grade of cardiac function, postoperative stroke, postoperative dialysis, perivalvular abscess and multivalve involvement are the independent risk factors for early mortality.

Early Mortality Risk in Patients with Multiple Myeloma

BACKGROUND: Advances in treatment has improved greatly survival of multiple myeloma in the last two decades, and this improvement has been endorsed by wider use of novel drugs and tandem autologous stem cell transplantation. However, still there were cases died earlier post diagnosis OBJECTIVES: To study the risk factors of early mortality in patients with multiple myeloma In Kurdistan region of Iraq PATIENTS AND METHODS: A 176 cases that were diagnosed with symptomatic multiple myeloma between (January 2012 – July 2019) in cancer centers in Kurdistan region of Iraq. A total of 152 were continued within the study through their recorded sheet. Their data were analysed to determine what are the main risk factors that have an impact on early mortality among our myeloma patients. RESULTS: Among the total of 152 studied patients nine of them (5.9%) died early. The highest proportion (32.2%) of the sample aged 60-69 years, more than half (57.2%) of the them were male. The majority of the patients (80.9%) have been diagnosed during 2016-2019. The incidence of early death was 8.7% among patients who didn’t take the cytotoxic treatment compared with 1.7% of patients who took that treatment, but the difference was not significant (p = 0.089). The early death rate was significantly high (22.2%) among patients who didn’t take the immunomodulatory drugs, versus 2.4% of patients who took the immunomodulatory drugs (p = 0.001). The incidence of early mortality was 9.6% among patients with lactate dehydrogenase of ≥ 250 U/L compared with 0%

Acil Serviste İnme Tanısı Alan Hastalarda Tam Kan Sayımı Parametreleri ve Erken Dönem Mortalite İlişkisi

ABSTRACT&#x0D; Background: Acute ischemic stroke is the most common cause of death after heart disease and cancer. We aimed to investigate the relationship between parameters of complete blood count in early period of ischemic stroke.&#x0D; Material Method: The study was organized as a retrospective-archive study. Patients applied Emergency Department and diagnosed as ischemic stroke were included. Demographic findings, complete blood count parameters, imaging tests, duration time in the emergency, hospitalization time were noted.&#x0D; Results: The mean age of 422 patients was 69.95 ± 12.26 years. Hypertension is the most common additional diseases, with the rate of 68.5%. While the mortality rate is 2.1% in the first 7 days, it was 5.2% in the first 30 days. The mean value of Neutrophil Lymphocyte Ratio (NLR) was significantly higher in patients who died within the first 7 days (p = 0.013). The sensitivity of NLR cut-off value, which was determined as 4.12 for death in the first 7 days, was 77.8% and specificity was 68.5%. Red Cell Distribution Width (RDW) values of patients who died within 30 days were found to be statistically significantly higher when compared to living patients. Advanced age, heart failure and atrial fibrillation were found to be significant risk factors for early mortality.&#x0D; Conclusion: In conclusion, NLR can be predictive for mortality within the first 7 days and RDW for mortality within the first 30 days. The presence of heart failure and / or atrial fibrillation and the age of 65 and above increase the risk of early mortality.&#x0D; &#x0D; Keywords: ischemic stroke, red cell distribution width, neutrophil lymphocyte ratio, early mortality

Prognostic Value of Initial Blood Cell Counts in Acute Myeloid Leukemia

Introduction: Acute myeloid leukemia (AML) is an aggressive hematologic malignancy that has a poor prognosis. Not only does AML lead to mortality, but toxicity from chemotherapy can result in life-threatening complications. While the goal of treatment for some AML patients is cure, if the risks of chemotherapy are substantial, then less aggressive treatment regimens, including no treatment, should be pursued. The goal of this study was to identify risk factors for early mortality among patients with AML who receive chemotherapy. Methods: This study was a retrospective chart review. From January 2015 to August 2019, patients who received chemotherapy for AML were included. Demographic and clinical characteristics were gathered from when the patient was first suspected to have AML: age, sex, race, body surface area (BSA), white blood cell count (WBC), hemoglobin, platelet count, lactate dehydrogenase (LDH), and uric acid. The outcome was weeks of survival from the first day of treatment. The independent samples Mann-Whitney Test was used for dichotomous comparisons. Results: Forty-nine patients were included in the study. Patients aged ≤65 years old had greater median survival than those &amp;gt;65 years old (40.36 weeks vs. 11.50 weeks, p=0.045). Patients with a hemoglobin &amp;gt;8 g/dL had greater median survival than those ≤8g/dL (45.43 weeks vs. 6.57 weeks, p&amp;lt;0.001). Patients with a platelet count &amp;gt;50,000/mm3 had greater median survival than those ≤50,000/mm3 (47.72 weeks vs. 8.29 weeks, p&amp;lt;0.001). Sex and race were not related to survival time nor were cutoffs for BSA, WBC, LDH, and uric acid. For the 23 of 49 patients who survived less than six months from the time they started chemotherapy, patients with a platelet count &amp;gt;50,000/mm3 had greater median survival than those ≤50,000/mm3 (11.29 weeks vs. 4.43 weeks, p=0.016). Also, for patients surviving less than six months, those with BSA &amp;gt;1.95 m2 had median survival of 10 weeks versus median survival of 4.5 weeks for BSA ≤1.95 m2 (p=0.07). Conclusion: For patients receiving chemotherapy for AML, we found that in addition to older age, lower hemoglobin and lower platelet count were risk factors for survival time and should be considered before embarking on an aggressive treatment regimen, as the risks may outweigh the benefits. Figure Disclosures No relevant conflicts of interest to declare.

Redo sternotomy versus left ventricular assist device explant as risk factors for early mortality following heart transplantation.

There is an increasing proportion of patients with a previous sternotomy (PS) or durable left ventricular assist device (LVAD) undergoing heart transplantation (HT). We hypothesized that patients with LVAD support at the time of HT have a lower risk than patients with PS and may have a comparable risk to patients with a virgin chest (VC). This is a single-centre retrospective cohort study of all adults who underwent primary single-organ HT between 2002 and 2017. Multivariable Cox regression analyses were performed to compare 30-day and 1-year mortality between transplanted patients with a VC (VC-HT), a PS (PS-HT) or an LVAD explant (LVAD-HT). Three hundred seventy-nine patients were analysed (VC-HT: 196, PS-HT: 94, LVAD-HT: 89). A larger proportion of patients in the LVAD-HT group were males (83%), had blood group O (52%), non-ischaemic aetiology (70%) and sensitization (67%). The PS-HT group had a higher frequency of patients with congenital heart disease (30%) and PSs compared to LVAD-HT patients (P < 0.001). PS-HT and LVAD-HT patients required a longer bypass time (P < 0.001) and showed a greater estimated blood loss (P < 0.001). Postoperatively, LVAD-HT required haemodialysis more frequently than the VC-HT group (P = 0.031). Multivariable analyses found that PS-HT patients had increased 30-day mortality compared to VC-HT [hazard ratio (HR) 2.63, 95% confidence interval (CI) 1.15-6.01; P = 0.022] while LVAD-HT did not (HR 2.17, 95% CI 0.96-4.93; P = 0.064). At 1-year, neither PS-HT nor LVAD-HT groups were significantly associated with increased mortality compared to VC-HT. Transplants in recipients with PS-HT demonstrated increased early mortality compared to VC-HT patients. Although LVAD explant is often technically challenging, this population demonstrated similar mortality compared to those VC-HT patients. The chronic and perioperative support provided by the LVAD may play a favourable role in early patient outcomes compared to other redo sternotomy patients.

Twenty-Year Experience with Truncus Arteriosus Repair: Changes in Risk Factors in the Current Era.

Although the clinical outcomes of truncus arteriosus (TA) repair have been improving, few data are available on long-term outcomes after truncus arteriosus repair in the current era. This study evaluated long-term outcome after repair of TA. Fifty-one patients underwent total correction from April 1982 to June 2018. Since 2003, perioperative strategy has changed to minimal priming volume, modified ultrafiltration, and early total repair (n = 26). Mortality and reoperation rates were analyzed before and after 2003. There were 8 hospital deaths after initial operation, all before 1997. During the mean follow-up of 9.8years, there were 2 deaths. The Kaplan-Meier estimate of survival among all hospital survivors was 94.7% at 5years and 88.0% at 20years. A significant independent risk factor for early mortality was operation before 2003 (Hazard ratio (HR) 9.710, p = 0.041) and REV operation (HR 8.000, p = 0.028). Freedom from reoperation for conduit change and TV repair were 88.3% and 41% at 1 and 5years, and 96.2% and 85.4% at 1 and 5years, respectively. After 2003, younger age and conduit choice were risk factors for conduit-related reoperation. Initial preoperative TV regurgitation was independent risk factor for sequential TV repair. Patients with TA can undergo total repair of TA with excellent results, especially in current era. Most of the patients require conduit-related reoperations. Younger age and the methods of RVOT reconstruction were risk factors for conduit-related reoperations. TV repair is necessary in limited patients, and initial regurgitation was a risk factor.

Epidemiology and risk factors associated with early onset neonatal sepsis in the south of KSA

ObjectivesThis study aims to describe the epidemiology of early onset sepsis (EOS) and its associated risk factors in a tertiary healthcare centre in the south of KSA. MethodsWe conducted a retrospective review of the medical records of neonates diagnosed with EOS at King Fahad Central Hospital (KFCH), Jazan, KSA. Data on the incidence, causative organisms, and related risk factors for EOS were collected. ResultsThe incidence of EOS in our sample was 4.44 per 1,000 live births during the study period. The most frequently isolated organisms from neonates were E. coli (29%), Group B streptococcus (GBS) (17%), and coagulase-negative Staphylococcus (11%). The gestational age and weight at birth of neonates who died within a week compared to those who survived were statistically different (p values < 0.05). Finally, the percentage of neonates found to be infected with E. coli was higher among neonates with either an extremely low birth weight or very low birth weight (p = 0.016). ConclusionsOur study shows a higher incidence of EOS in KFCH in the Jazan region compared to similar clinical settings in KSA. Identifying pre-term birth weight and low birth weight as possible risk factors of early mortality of infants with EOS may necessitate the need for reassessment of antenatal care services in the region.

ABCL-136: Early Deaths in Childhood Burkitt's Lymphoma: A Major Challenge in Developing Countries

Context: The outcome of childhood Burkitt's lymphoma (BL) has improved steadily over the past decades through the use of intensive sequential multi-agent chemotherapy regimens with increased concern about increasing toxicity-related mortality. Objective: This study objective was to assess incidence and risk factors of early mortality in BL. Design/Setting: A retrospective study included all patients 18 years old or younger diagnosed with BL and treated according to the modified LMB 96 protocol at National Cancer Institute, Cairo University from January 2012 to December 2016. Patients or other participants: A total of 170 patients were diagnosed with BL, with a median age of 5 years old. Abdominal presentation was the most common primary site (90.0%). Sixty-two (36.5%) patients were diagnosed as early as less than or equal to 2 weeks and 108 (63.5%) patients were diagnosed beyond 2 weeks from onset of symptoms. A total of 82 (48.2%) patients presented by disease-related emergencies, 49 patients (59.7%) of them with acute renal impairment due to TLS, and 33 (40.2%) had intestinal obstruction and/or complications. Main outcome measures: Total and early deaths (during reduction and 1st induction phase of therapy) were measured and the underlying causes of early mortalities were also reported. Results: Throughout the whole treatment duration, 39 (23%) total deaths were reported and 50% of them (n=19) died before 2nd induction (early mortality). Eleven patients (57.8%) of them died in the first week, 6/11 patients died before completing the 1st CVP. The main causes of early mortalities were sepsis in 58% and acute renal failure due to TLS in 42% of cases. The 5-year overall survival (OS) and event-free survival (EFS) were 82.9% and 82.8%, respectively for the whole group. Conclusions: Early deaths and treatment-related toxic mortalities remain the major challenge affecting outcome in our patients. Early diagnosis and enhanced supportive care measures are essential to improve the outcome for those group of patients.

Neonatal surgical outcomes after prenatal diagnosis of complex congenital heart disease: experiences of a perinatal integrated diagnosis and treatment program.

This study aimedto evaluate neonatal surgical outcomes of patients diagnosed with complex congenital heart disease (CHD) during pregnancy and treated by the newly initiated "perinatal integrated diagnosis and treatment program (PIDTP)". We reviewed clinical data of 207 neonates (surgical age ≤ 28days) who underwent cardiac surgeries in a single center from January 2017 to December 2018, including 31 patients with referrals from the "PIDTP" (integration group) and 176 patients with routine referral treatment (non-integrated group). In the integration group, median admission age was 0days and median age at surgery was 4days. In the non-integrated group, median admission age was 8days (P = 0.001) and median age at surgery was 13days (P = 0.001). The emergency surgery rate in patients with duct-dependent defects was 36% in the integration group and 59% (P = 0.042) in the non-integrated group, respectively. The in-hospital mortality was 16% in the integration group and 14% (P = 0.78) in the non-integrated group. The 2-year cumulative survival rate after surgery was 83.9% ± 6.6% in the integration group and 80.3% ± 3.1% (P = 0.744) in the non-integrated group. According to multivariable regression analysis, independent risk factors for early mortality of overall neonatal cardiac surgery were low body weight, high serum lactate level, postoperative extracorporeal membrane oxygenation (ECMO) support and prolonged cardiopulmonary bypass (CPB) time. PIDTP shortens the postnatal transit interval, reduces the emergency operation rate of neonatal critical CHD, and provides better preoperative status for surgery. Patients treated by the PIDTP tend to have more complicated anatomical deformity and a greater requirement for the operation and postoperative management, but early outcome and follow-up prognosis are satisfactory.

Clinical risk factors for early mortality in patients with community-acquired septic shock. The importance of adequate source control.

To evaluate the incidence and risk factors for early mortality (EM) in the ICU in patients with community-acquired septic shock (CASS). A retrospective cohort study of patients with CASS admitted to the ICU (2003-2016). ICU at a University Hospital in Spain. All consecutive patients admitted to the ICU with CASS. None. CASS was defined according to the Sepsis-3 definitions. EM were defined as occurring within of 72h following ICU admission. A multinomial logistic regression analysis was performed to identify the risk factors associated with early deaths. During the study period, 625 patients met the Sepsis-3 criteria and admitted with CASS. 14.4% of all patients died within the first 72h. Of 161 patients who died in the ICU, 90 (55.9%) died within the first 72h. The percentage of early and late mortality did not vary significantly during the study period. The need and adequacy of source control were significantly lower in patients with EM. In the multivariate analysis, ARDS, non-respiratory infections, bacteremia and severity at admission were variables independently associated with EM. The only factor that decreased EM was adequate source control in patients with infections amenable to source control. The incidence of EM has remained stable over time, which means that more than half of the patients who die from CASS do so within the first 72h. Infections where adequate source control can be performed have lower EM.

Immunodeficiency in cartilage-hair hypoplasia: Pathogenesis, clinical course and management.

Cartilage-hair hypoplasia (CHH) is an autosomal recessive syndromic immunodeficiency with skeletal dysplasia, short stature, hypotrichosis, variable degree of immune dysfunction and increased incidence of anaemia, Hirschsprung disease and malignancy. CHH is caused by variants in the RMRP gene, encoding the untranslated RNA molecule of the mitochondrial RNA-processing endoribonuclease, which participates in for example cell cycle regulation and telomere maintenance. Recent studies have expanded our understanding of the complex pathogenesis of CHH. Immune dysfunction has a major impact on clinical course and prognosis. Clinical features of immune dysfunction are highly variable, progressive and include infections, lung disease, immune dysregulation and malignancy. Mortality is increased compared with the general population, due to infections, malignancy and pulmonary disease. Several risk factors for early mortality have been reported in the Finnish CHH cohort and can be used to guide management. Newborn screening for severe combined immunodeficiency can possibly be of prognostic value in CHH. Regular follow-up by a multidisciplinary team should be implemented to address immune dysfunction in all patients with CHH, also in asymptomatic cases. Haematopoietic stem cell transplantation can cure immune dysfunction, but its benefits in mildly symptomatic patients with CHH remain debatable. Further research is needed to understand the mechanisms behind the variability of clinical features, to search for potential molecular treatment targets, to examine and validate risk factors for early mortality outside the Finnish CHH cohort and to develop management guidelines. This review focuses on the pathogenesis, clinical course and management of CHH.

Social isolation, loneliness and health in the time of COVID

Humans are social beings. We rely on others for our survival and well-being. Lack of social relationships have an enormous impact on our physical and emotional health and are a stronger risk factor for early mortality than most traditional health risk factors [1]. Our social connections have been threatened by the COVID-19 pandemic

Sex-specific risk factors for early mortality and survival after surgery of acute aortic dissection type a: a retrospective observational study

BackgroundAlthough gender-related disparities in cardiovascular surgery have been investigated extensively in the past decades, knowledge about the impact of gender on outcomes after surgery for acute aortic dissection type A (AADA) is sparse. This study investigated the impact of gender on early morbidity and mortality and follow-up outcome in patients after surgery for AADA and to analyze gender-related risk factors for 30-day mortality.MethodsThis retrospective study included 368 consecutive patients (male 65.8% vs. female 34.2%) undergoing surgery for AADA between 2001 and 2016 at our department. Survival was estimated by Kaplan-Meier curves. Risk factors for 30-day mortality were assessed by multivariable logistic regression and interaction analysis.ResultsWomen were older (70.7 years vs. 60.6 years; p < 0.001) and showed a higher logistic EuroSCORE I (31.0% vs. 19.7%, p < 0.001). In the male group, a higher portion of smokers (27.6% vs. 16.0%, p = 0.015) and intraoperatively, more complex procedures and longer cardiopulmonary bypass (CPB) (171 min vs. 149 min, p = 0.001) and cross-clamping times (94 min vs. 85 min, p = 0.018) occurred. 30-day mortality was 19.0% in the female and 16.5% in the male group (p = 0.545). Predictive for 30-day mortality in both genders was intraoperative blood transfusion, while in the female group chronic obstructive pulmonary disease (COPD), peripheral arterial disease and preoperative intubation were predictive. Preoperative cardiopulmonary resuscitation and duration of CPB time were predictors only in males. Averaged follow-up time was 5.2 years and survival did not differ between genders, even if it was stratified by age over 70 years.ConclusionsThis analysis demonstrated a similar and satisfactory survival in both genders after surgical treatment of AADA. Women and men differed significantly in age, unadjusted and adjusted risk factors and complexity of surgical treatment, but gender itself was no risk factor for mortality. These results suggest that the decision-making for surgical treatment should not depend on gender, but that accounting for sex-specific risk factors rather than common risk factors may help to improve the outcome in both genders.

Risk factors of early mortality after neonatal surgery in Tunisia

BackgroundResearch concerning factors of death after neonatal surgery is scarce. Insight into mortality might improve perioperative care. This study aimed to identify predictive factors of mortality after neonatal surgery in a low income country (LIC). MethodsCharts of all newborn patients who underwent surgical procedures under general anesthesia during the neonatal period in our department of pediatric surgery between January 2010 and December 2017 were reviewed. We used univariate and multivariate analysis to evaluate perioperative variables potentially predictive of early postoperative mortality. ResultsOne hundred eighty-two cases were included in the study: 41 newborns (28.6%) were premature (<37 weeks of gestation) and 52 (22.5%) weighed less than 2.5 kg. The most commonly diagnosed conditions were esophageal atresia (24%) and bowel obstruction (19%).Forty-four patients (24%) died during hospitalization. The highest rate of mortality was observed for congenital diaphragmatic hernia. Univariate analysis showed that perinatal predictive variables of mortality were prematurity, low birth weight, the necessity of preoperative intubation, and duration of surgery more than 2 h. Logistic regression showed three independent risk factors, which are the duration of surgery, low birth weight and the necessity of preoperative intubation. ConclusionThe overall mortality in infants undergoing neonatal surgery is still high in LICs.Knowledge of independent risk factors of early mortality may help clinicians to more adequately manage the high-risk population. Type of the studyClinical research paper. Level of evidenceIII.

Truncus arteriosus repair: A 40-year multicenter perspective

ObjectiveTo examine the long-term surgical outcomes of patients who underwent truncus arteriosus (TA) repair. MethodsBetween 1979 and 2018, a total of 255 patients underwent TA repair at 3 Australian hospitals. Data were obtained by review of medical records from initial admission until last cardiology follow-up. ResultsAt the time of TA repair, the median patient age was 44 days, and median weight was 3.5 kg. Early mortality was 13.3% (34 of 255), and overall survival was 76.8 ± 2.9% at 20 years. Neonatal surgery and low operative weight were risk factors for early mortality. Most deaths (82.5%; 47 of 57) occurred within the first year following repair. A coronary artery anomaly and early reoperation were identified as risk factors for late mortality. A total of 175 patients required at least 1 reoperation, with overall freedom of reoperation of 2.9 ± 1.5% at 20 years. Follow-up of survivors was 96% complete (191 of 198). The median duration of follow-up was 16.4 years. At the last follow-up, 190 patients were categorized as New York Heart Association class I/II, and 1 patient was class III. ConclusionsTA repair during the neonatal period presents significant surgical challenges. Neonates with signs of overcirculation should be operated on promptly. A coronary artery anomaly is a risk factor for late mortality. Survival beyond the first year following repair is associated with excellent outcomes.

Pediatric Glioma Outcomes: Predictors of Early Mortality

To assess the early mortality in pediatric glioma and identify predictors of early mortality, which may provide insight into the therapeutic strategies for children with a high risk of early mortality. We used SEER∗Stat 8.3.5 software to extract data of pediatric glioma from the Surveillance, Epidemiology, and End Results database. Logistical regression to identify the independent factors in predicting early mortality. A total of 3035 male and 2741 female patients were enrolled in the present study. The death rates within 1 month and 3 months after diagnosis were 1.32% and 2.44%, respectively. Early mortality decreased significantly during the past 40 years. Our results showed that glioblastoma, anaplastic glioma, and oligodendroglioma were risk factors of early mortality for children diagnosed with glioma, whereas advanced age, gross total resection, radiation, and chemotherapy were associated with decreased early mortality. We found a decrease in early mortality during the past 40 years. The death rates within 1 month and 3 months after diagnosis were 1.32% and 2.44%, respectively. Age at diagnosis, histologic subtype, the extent of resection, chemotherapy, and radiation were associated with early mortality in pediatric glioma.

Racial/Ethnic Disparities in the Burden of HIV/Cervical Cancer Comorbidity and Related In-hospital Mortality in the USA.

The purpose of this study was to determine whether cervical cancer is a risk factor for early mortality among women with HIV and whether racial/ethnic disparity predicted in-hospital death among women living with HIV and diagnosed with cervical cancer. We conducted a population-based study using the National Inpatient Sample (NIS) database comprising hospitalized HIV-positive women with or without cervical cancer diagnosis, from 2003 through 2015. We compared trends in the rates of cervical cancer, in-hospital death, and years of potential life lost (YPLL) by race/ethnicity. We identified 2,613,696 women with HIV, and among them, 5398 had cervical cancer. The prevalence of cervical cancer (per 10,000) was 9.3 for NH-Whites, 30.9 among NH-Blacks, and 30.2 for Hispanics. Rates of cervical cancer over time diminished significantly only among NH-Whites (average annual percent change (AAPC), - 5.8 (- 9.7, - 1.8)), and YPLL in women with cervical cancer decreased significantly only in NH-Whites (AAPC, - 6.2 (- 10.1, - 2.0)). Cervical cancer was associated with increased odds of in-hospital death overall (OR 2.24 (1.59-3.15)) and among NH-Blacks (OR 2.03 (1.30-3.18)) only. NH-Blacks and Hispanics with HIV remain at increased risk for concurrent diagnosis of cervical cancer compared with NH-Whites. Moreover, NH-Black women with HIV and cervical cancer are at greatest risk for in-hospital death. The findings emphasize the need for a more robust prevention strategy among minority women to reduce the high burden of HIV/cervical cancer and related mortality.

The relationship between hopelessness and risk factors for early mortality in people with a lived experience of a serious mental illness

ABSTRACT The purpose of this study was to explore the relationships between self-reported hopelessness and risk factors for premature mortality in people with serious mental illness (SMI). Data were extracted from the 2014 Health Center Patient Survey (N = 5,592). Having a diagnosis of SMI was significantly associated with self-reported hopelessness. Hypertension or high blood pressure, congestive heart failure, and chronic obstructive pulmonary disorder were significantly associated with self-reported hopelessness. Higher levels of hopelessness were found to be significantly associated with increased alcohol consumption. Hopelessness may be an important dimension of health in people with SMI.