Risk Factor For Worse Outcomes Research Articles

Abstract PO5-10-02: Neighborhood deprivation index and time to initiation in patients with metastatic breast cancer

Abstract Background Cyclin-dependent kinase 4 and 6 inhibitors (CDKi) are first-line therapy for patients with estrogen-positive (ER+) metastatic breast cancer (MBC). The accessibility, usability, and outcomes according to demographic factors have not been well studied in real world practice. Methods Retrospective review of patients with ER+ MBC prescribed first line CDKi therapy at a large NCI-designated cancer center from January 2015 through December 2022. Patient records were abstracted for outcomes including 1) time from CDKi prescription to drug initiation (TTI), 3) time from CDKi initiation to progression, and 3) time from CDKi initiation to death/or 6/30/2022. Patient variables collected were: patient age (continuous), race (patient self-report – Black, White, Other), partner status (Married, Not married), Insurance type (Medicare, Medicaid, Private); Mean BMI; Number of comorbidities (5 categories). Neighborhood deprivation index (NDI) was determined from the patient’s address with higher scores indicating more deprivation. Descriptive, comparative, and correlational statistics were used. Results A total of 173 patients were included in the analysis. Mean age – 63.1, (SD 12.7, range 24-94); race – White n=157, Black n=16; marital status – Married n=102, Not married n=71; mean NDI – 61.0 (SD 23.7, range 6-100); mean BMI – 28.9 (SD 6.9, range 16-48); number of comorbidities – 0 n=35, 1-2 n= 35, 3-4 n = 55, 5-6 n = 20, 7+ n = 28; insurance type – Medicare n = 115, Medicaid n = 21, Private n = 37. TTI: the median TTI was 14 days. There were no statistically significant differences in TTI based on age, race, NDI, or other demographic variables. Time to progression: in the multivariate model, younger age at diagnosis and Medicaid insurance were associated with shorter time to progression. Overall survival: not married, younger age at diagnosis, and Medicaid insurance were associated with shorter overall survival. Discussion Demographic factors are associated with diverse outcomes of MBC therapy, not attributed to delay in CDKi treatment initiation. Personalization of support during MBC illness according to risk factors for worse outcomes may help to equalize incomes. Citation Format: Sneha Rajendran, Dianxu Ren, Marina Petruzzi, Margaret Rosenzweig. Neighborhood deprivation index and time to initiation in patients with metastatic breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-10-02.

Early Hypophosphatemia as a Prognostic Marker in Acute Pancreatitis.

Acute pancreatitis (AP) is a complex disease representing a significant portion of gastrointestinal-related hospitalizations in the U.S. Understanding risk factors of AP might provide attractive therapeutic targets. We evaluated hypophosphatemia as a risk factor for worse outcomes in AP. We performed a retrospective review of electronic health records of patients with AP admissions from 01/01/2012-12/31/2021 at Cedars-Sinai Medical Center, evaluating patients with serum phosphate measured within 48 hours of admission. Multivariable logistic regression modeling was employed to evaluate associations with ICU admission, AP severity, and a multivariable log-linear model was employed to examine associations with length of stay (LOS). Of 1,526 patients admitted for AP, 33% (499) had a serum phosphate level measured within 48 hours. Patients with hypophosphatemia were more likely to have been admitted to the ICU (AOR = 4.57; 95% CI: 2.75-7.62; P < 0.001), have a longer hospital stay (log-LOS = 0.34; SE; 0.09; 95% CI: 0.17-0.52; P < 0.001), and were more likely to have moderate or severe AP (AOR = 1.80; 95% CI: 1.16-2.80; P < 0.001) compared to those without hypophosphatemia. Serum phosphate is infrequently measured in patients with AP and shows promise as a rapid, inexpensive, and early prognostic marker for worse outcomes of AP.

Prognostic value of peripheral blood neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, pan-immune-inflammation value and systemic immune-inflammation index for the efficacy of immunotherapy in patients with advanced gastric cancer.

Aim: The study aimed to assess the value of pretreatment peripheral blood neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), pan-immune-inflammation value (PIV) and systemic immune-inflammation index (SII) for predicting immunotherapy prognosis and efficacy in advanced gastric cancer (GC). Methods:A total of84 advanced GC patients received immunotherapy were retrospectively collected. The optimal cut-off values were determined by receiver operating characteristic curves. The univariate and multivariate analysis investigated the effects of NLR, PLR, PIV and SII on patients prognosis. Results: NLR, PLR, PIV and SII had predictive value of efficacy. NLR ≥3.65 was an independent risk factor for worse outcomes. Conclusion: NLR, PLR, PIV and SII have predictive value of efficacy and NLR ≥3.65 suggests a poor prognosis following immunotherapy in advanced GC.

The impact of obesity on ventilator-associated pneumonia, a US nationwide study

BackgroundVentilator-associated pneumonia (VAP) is one of the leading causes of mortality in patients with critical care illness. Since obesity is highly prevalent, we wanted to study its impact on the outcomes of patients who develop VAP.MethodsUsing the National Inpatient Sample (NIS) database from 2017 to 2020, we conducted a retrospective study of adult patients with a principal diagnosis of VAP with a secondary diagnosis with or without obesity according to 10th revision of the International Statistical Classification of Diseases (ICD-10) codes. Several demographics, including age, race, and gender, were analyzed. The primary endpoint was mortality, while the secondary endpoints included tracheostomy, length of stay in days, and patient charge in dollars. Multivariate logistic regression model analysis was used to adjust for confounders, with a p-value less than 0.05 considered statistically significant.ResultsThe study included 3832 patients with VAP, 395 of whom had obesity. The mean age in both groups was around 58 years, and 68% of the group with obesity were females compared to 40% in females in the group without obesity. Statistically significant comorbidities in the obesity group included a Charlson Comorbidity Index score of three and above, diabetes mellitus, hypertension, chronic kidney disease, and sleep apnea. Rates and odds of mortality were not significantly higher in the collective obesity group 39 (10%) vs. 336 (8.5%), p-value 0.62, adjusted odds ratio 1.2, p-value 0.61). The rates and odds of tracheostomy were higher in the obesity group but not statistically significant. Obese patients were also found to have a longer hospitalization. Upon subanalysis of the data, no evidence of racial disparities was found in the care of VAP for both the obese and control groups.ConclusionsObesity was not found to be an independent risk factor for worse outcomes in patients who develop VAP in the intensive care unit.

Thoracic aortic aneurysms, a single center's 10-years experience and analysis of outcomes.

Thoracic aortic aneurysms (TAAs) are an increasingly prevalent pathology with significant associated morbidity and mortality. Thoracic endovascular aortic repair (TEVAR) is the primary line of treatment. The purpose of this study was to analyse a single center's experience in the treatment of TAAs and identify possible risk factors for worse outcomes. A retrospective review of our institutional database was done to identify all patients treated for TAAs in a 10-year period, from 1 January 2012 to 31 December 2022. Data were extracted from patients' medical records. Primary outcome was all-cause mortality and secondary outcomes were procedure related morbidity (vascular access complications, medullary ischaemia, stroke, endoleaks, migration, aneurysm sac enlargement >5mm) and need for reintervention at 1-, 6- and 12-month follow-up. A descriptive and inferential analysis of the data was performed. Statistical analyses were conducted using the IBM Statistical Package for Social Sciences (SPSS) software. We identified 34 patients treated for TAAs in this period. Mean age was 68years [47-87] and 79.4% of patients were male. Mean aneurysm diameter was 63mm [35-100], 55.9% fusiform and 44.1% saccular. The majority (91.2%) were located at the descending thoracic aorta and 3 (8.8%) of them extended to the aortic arch. The most common aetiology was degenerative in 22 patients (64.7%), followed by aortic dissection in 8 patients (23.5%). Elective surgery was performed in 19 (61.3%) patients and 12 (38.7%) had urgent repair. TEVAR was the treatment of choice in 24 (77.4%) patients, and the remaining 7 (22.6%) were treated with hybrid surgery. Mean length of hospital stay was 10days [2-80] (6 days for elective repair versus 16days for urgent repair, p = .016). Follow-up period ranged from 1month to 10years. At 1 year follow-up, all-cause mortality was 15%, morbidity was 30% (with 6 (22%) patients having a type Ia endoleak) and need for reintervention was 22%. Aneurysm diameter was a significant risk factor for procedure related morbidity (median diameter of 73.5mm versus 56.0mm in patients with no morbidity; p = .027). The presence of type Ia endoleak was significantly associated with higher reintervention rates (p = .001), but not with higher mortality rates (p = .515). Age, female sex, aetiology and urgent repair weren't associated with any significant differences in the outcomes. TEVAR proved to be effective in the treatment of TAAs, with good outcomes at short and mid-term follow-up. TAAs should be diagnosed earlier and be promptly treated when meeting criteria to prevent worse outcomes.

Complex karyotype but not other cytogenetic abnormalities is associated with worse posttransplant survival of patients with nucleophosmin 1-mutated acute myeloid leukemia: A study from the European Society for Blood and Marrow Transplantation Acute Leukemia Working Party.

In the 2022 European LeukemiaNet classification, patients with nucleophosmin 1 (NPM1)-mutated acute myeloid leukemia (AML) were classified in the adverse-risk category in the presence of high-risk cytogenetics (CG). Nonetheless, the impact of various CG aberrations on posttransplant outcomes remains to be unraveled. This registry study analyzed adult patients with NPM1-mutated de novo AML who underwent their first allogeneic hematopoietic cell transplantation in the first complete remission from 2005 to 2021. A total of 3275 patients were identified, 2782 had normal karyotype, 493 had chromosomal aberrations including 160 with adverse-risk CG, 72 patients had complex karyotype (CK), and 66 monosomal karyotype (MK). Overall, 2377 (73%) patients had FLT3-ITD. On univariate analysis, only FLT3-ITD, minimal/measurable residual disease (MRD) positivity and CK, but not abnormal CG, affected posttransplant outcomes. On multivariable analysis, CK was associated with lower overall survival (OS) (hazard ratio [HR] 1.72, p = .009). In the subgroup of 493 patients with aberrant CG, the 2-year leukemia-free survival (LFS) and OS were around 61% and 68%, respectively. On multivariable analysis for this subgroup, CK and MRD positivity were associated with increased risk of relapse (HR 1.7, p = .025; and 1.99, p = .003 respectively) and worse LFS (HR 1.62, p = .018; and 1.64, p = .011 respectively) while FLT3-ITD, MK, or other CG abnormalities had no significant effect. Importantly, CK negatively affected OS (HR 1.91, p = .002). In the first complete remission transplant setting, CK was found as the only cytogenetic risk factor for worse outcomes in NPM1-mutated AML. Nevertheless, even for this subgroup, a significant proportion of patients can achieve long-term posttransplant survival.

Impact of Anti-angiogenic Drugs on Severity of COVID-19 in Patients with Non-Small Cell Lung Cancer.

Introduction: The 2019 coronavirus disease (COVID-19) pandemic has reshaped oncology practice, but the impact of anti-angiogenic drugs on the severity of COVID-19 in patients with non-small cell lung cancer (NSCLC) remains unclear. Patients and Methods: We carried out a retrospective study involving 166 consecutive patients with NSCLC who were positive for COVID-19, aiming to determine the effects of anti-angiogenic drugs on disease severity, as defined by severe/critical symptoms, intensive care unit (ICU) admission/intubation, and mortality outcomes. Risk factors were identified using univariate and multivariate logistic regression models. Results: Of the participants, 73 had been administered anti-angiogenic drugs (termed the anti-angiogenic therapy (AT) group), while 93 had not (non-AT group). Comparative analyses showed no significant disparity in the rates of severe/critical symptoms (21.9% vs 35.5%, P = 0.057), ICU admission/intubation (6.8% vs 7.5%, P = 0.867), or death (11.0% vs 9.7%, P = 0.787) between these two groups. However, elevated risk factors for worse outcomes included age ≥ 60 (odds ratio (OR): 2.52, 95% confidence interval (CI): 1.07-5.92), Eastern Cooperative Oncology Group performance status of 2 or higher (OR: 21.29, 95% CI: 4.98-91.01), chronic obstructive pulmonary disease (OR: 7.25, 95% CI: 1.65-31.81), hypertension (OR: 2.98, 95% CI: 1.20-7.39), and use of immunoglobulin (OR: 5.26, 95% CI: 1.06-26.25). Conclusion: Our data suggests that the use of anti-angiogenic drugs may not exacerbate COVID-19 severity in NSCLC patients, indicating their potential safe application even during the pandemic period.

Radiotherapy intensification for atypical and malignant meningiomas: A systematic review.

The outcomes of nonbenign (WHO Grades 2 and 3 [G2, G3]) meningiomas are suboptimal and radiotherapy (RT) dose intensification strategies have been investigated. The purpose of this review is to report on clinical practice and outcomes with particular attention to RT doses and techniques. The PICO criteria (Population, Intervention, Comparison, and Outcomes) were used to frame the research question, directed at outlining the clinical outcomes in patients with G2-3 meningiomas treated with RT. The same search strategy was run in Embase and MEDLINE and, after deduplication, returned 1 807 records. These were manually screened for relevance and 25 were included. Tumor outcomes and toxicities are not uniformly reported in the selected studies since different endpoints and time points have been used by different authors. Many risk factors for worse outcomes are described, the most common being suboptimal RT. This includes no or delayed RT, low doses, and older techniques. A positive association between RT dose and progression-free survival (PFS) has been highlighted by analyzing the studies in this review (10/25) that report the same endpoint (5y-PFS). This literature review has shown that standard practice RT leads to suboptimal tumor control rates in G2-3 meningiomas, with a significant proportion of disease recurring after a relatively short follow-up. Randomized controlled trials are needed in this setting to define the optimal RT approach. Given the increasing data to suggest a benefit of higher RT doses for high-risk meningiomas, novel RT technologies with highly conformal dose distributions are preferential to achieve optimal target coverage and organs at risk sparing.

Immune-Suppression Modulation in Solid Organ Transplant Recipients Admitted for COVID-19

SARS-CoV-2 infection has significantly impacted solid organ transplant (SOT) recipients, who are at high risk of disease and worse outcomes. Moreover, therapeutic management in this population is not precise yet. Our study aimed to evaluate the overall survival of SOT recipients and predictive factors for mortality. We also aimed to assess the impact of antiviral treatments and immunosuppressant changes on overall mortality and to evaluate the length of hospital stay of SOT compared to the general population. This is a retrospective monocenter study. We included all SOT recipients with laboratory-confirmed SARS-CoV2 infection admitted at Niguarda Hospital in Milan from February 2020 through January 2022. We enrolled 74 solid organ transplant recipients with a median age of 59. The overall mortality rate was 19%. Older age, male sex, diabetes, and high LDH values were associated with an increasing fatality rate. The median length of stay (LoS) was 17 days. Low white blood count and lymphocyte levels were associated with 19 days LoS. Changes in immunosuppression and SARS-CoV-2 antiviral therapies had no impact on mortality and LoS. In this study, we confirm previously described risk factors for worse outcomes. We did not observe beneficial therapies in terms of mortality rate and LoS. Seven patients received antiviral treatment. More studies are needed to assess the best therapeutical options, including immunosuppressant modulation, in SOTs.

Lenalidomide Maintenance in Multiple Myeloma: A Retrospective, Nationwide, Real-World Study

Introduction: Lenalidomide maintenance (LM) has shown progression-free (PFS) and overall survival (OS) benefit in clinical trials and is the recommended standard of care in patients with newly diagnosed multiple myeloma (MM) after high-dose melphalan and autologous stem cell transplantation (HDM-ASCT). In Denmark, LM has been approved for all patients treated with HDM-ASCT since June 2019 and is publicly funded. That LM was made available nationwide simultaneous across all regions creates a unique opportunity to study the real-world use pattern, efficacy, and adverse effects of LM in an unselected, population-based cohort without referral bias. Methods: Patients with newly diagnosed MM treated with their first HDM-ASCT between June 2019 and March 2022 were included and followed until data cut-off in June 2023. To compare outcomes, a historical pre-LM cohort from the Danish MM Registry, consisting of MM patients treated with HDM-ASCT between June 2015 and June 2019, was used. Baseline clinical characteristics were acquired from the Danish MM Registry. To avoid the risk of guarantee-time bias, several strategies were applied. Early discontinuation of LM was studied using landmark analysis at 6 months after initiation of LM. For comparison with the pre-LM cohort, survival time was calculated from date of ASCT to progression or death for PFS and death of any cause for OS. Cox proportional hazards regression was used to calculate hazard ratios. Multivariate adjustment was made for age and sex as well as known risk factors for worse outcome: ISS and high-risk cytogenetics. Results: Lenalidomide maintenance cohort: Among 364 patients treated with HDM-ASCT after June 2019, 22.3% received consolidation therapy, and 3.7% underwent tandem HDM-ASCT. During follow-up, 297 patients (81.6%) initiated maintenance therapy, with 277 (76.1%) receiving LM. Overall, 145 patients (52.3%) discontinued LM most commonly due to toxicity 75 (51.7%), with fatigue (30.7%), cytopenia (25.3%), and neuropathy (17.3%) being the main reasons. During follow up, 119 (32.7%) patients had an event of progressive disease or death and 38 died. Only 1 death was related to Covid-19. To study the impact of early discontinuation of LM on clinical outcomes a 6-month landmark analysis was conducted. Early discontinuation did not negatively impact PFS, HR 0.92 (95% CI: 0.50, 1.70) or OS, HR 1.12 (0.25, 5.12). Results were similar in a 12-month landmark analysis. Comparison to the pre-lenalidomide maintenance cohort: A cohort of 364 multiple myeloma patients treated before the introduction of lenalidomide maintenance was used as comparison (pre-LM cohort). In that we take advantage of the randomness in being treated for MM in the years before and after the approval of lenalidomide. As the inclusion to either cohort was solely defined by the date of HDM-ASCT baseline characteristics were well balanced as expected with a median age of 61.1 vs 61.8 in the LM cohort and pre-LM cohort, respectively. By chance the dates of inclusion resulted in equal numbers of participants in both cohorts. We confirmed that lenalidomide maintenance was not routinely used before the approval in June 2019 by reviewing the electronic records of all patients treated with HDM-ASCT between January and June 2019. Of these, only 3 (7%) received LM, and in each case, LM was initiated just prior to approval. The LM cohort had similar PFS, HR 0.82 (0.65, 1.04), and OS HR 1.22 (0.78, 1.89) compared to the pre-LM cohort in unadjusted analysis, Figure 1. Results were similar after multivariate adjustment. The 3-year PFS and OS rates in the LM cohort were 61% (95 CI: 55%, 67%) and 86% (95 CI: 82%, 91%), respectively, while the pre-LM cohort had a 3-year PFS of 55% (50%, 60%) and a 3-year OS of 89% (86%, 93%). Conclusion: In this study encompassing all Danish patients with MM treated with HDM-ASCT since the introduction LM, we found that LM was initiated in approximately three out of four patients. One third of patients treated with LM discontinued this treatment within the first year, mainly due to toxicity. Early discontinuation of LM was not associated with worse clinical outcomes. When comparing post-transplantation PFS and OS in two cohorts of patients treated before and after the approval of LM, respectively, we found no differences.

Renal Failure in Patients with Newly Diagnosed Multiple Myeloma Eligible for Autologous Stem Cell Transplant in LATAM - on Behalf of Gelamm

Background Renal failure (RF) is a well-known complication in patients with multiple myeloma (MM). It is reported that RF occurs in 20% to 50% of patients at the time of diagnosis. Approximately 10% will require hemodialysis. It is important to consider that RF determines a worse short-term prognosis and decreased survival in these patients, especially for those requiring dialysis. Methods An international, multicenter, retrospective observational cohort study was conducted. Data were collected from the GELAMM retrospective Registry. We analyzed demographical and clinical characteristics, and overall survival (OS) of newly diagnosed MM patients without RF, patients with RF not requiring hemodialysis (HD), and patients with RF requiring HD. The logistic regression model was used to identify risk factors for worse outcomes. Results We included 1104 NDMM patients ≤ 65 years old from GELAMM registry: 854 patients without renal failure, 161 patients (15%) with RF not requiring HD, and 89 patients (8%) requiring HD. There were no differences in terms of demographic and clinical characteristics. With a median follow-up time of 29 months, the median OS was not reached (NR) in patients without RF and in patients with RF without HD requirement, however, it was 43 months (27 - 58 months) in patients with renal failure requiring HD (p=&amp;lt;0.001). The HR for mortality in patients with RF without HD was 1.75 (1.27 -2.41) and for RF and HD 3.49 (2.47 - 4.93) (p&amp;lt; 0.001). The one-year mortality among the three groups was 7% for patients without RF, 12% in patients with RF not requiring dialysis, and 30% in patients with RF requiring dialysis. The multivariate analysis showed that having proceeded with ASCT as a favorable prognostic factor HR 0.238 (0.129-0.521) p&amp;lt; 0.001 and high-risk cytogenetics as an unfavorable prognostic factor HR 2.936 (1.242-6.922) p=0.014. Discussion Renal failure confers a worse prognosis in Latin American patients with newly diagnosed multiple myeloma, especially for those who require dialysis, and increases one-year mortality more than 4 times. The use of ASCT decreases the risk of worse time-dependent outcomes, and high-risk cytogenetics increases the risk of death.

Older Adults with Epilepsy and COVID-19: Outcomes in a Multi-Hospital Health System

BackgroundCoronavirus disease 2019 (COVID-19) is associated with high rates of mortality and morbidity in older adults, especially those with pre-existing conditions. There is little work investigating how neurological conditions affect older adults with COVID-19. We aimed to compare in-hospital outcomes, including mortality, in older adults with and without epilepsy. MethodsThis retrospective study in a large multicenter New York health system included consecutive older patients (age ≥65 years) either with or without epilepsy who were admitted with COVID-19 between 3/2020-5/2021. Epilepsy was identified using a validated International Classification of Disease (ICD) and antiseizure medicationbased case definition. Univariate comparisons were calculated using Chi-square, Fisher's exact, Mann-Whitney U, or Student's t-tests. Multivariable logistic regression models were generated to examine factors associated with mortality, discharge disposition and length of stay (LOS). ResultsWe identified 5384 older adults admitted with COVID-19 of whom 173 (3.21%) had epilepsy. Mean age was significantly lower in those with (75.44, standard deviation (SD): 7.23) compared to those without epilepsy (77.98, SD: 8.68, p=0.007). Older adults with epilepsy were more likely to be ventilated (35.84% vs. 16.18%, p<0.001), less likely to be discharged home (21.39% vs. 43.12%, p<0.001), had longer median LOS (13 days vs. 8 days, p<0.001), and had higher in-hospital death (35.84% vs. 28.29%, p=0.030) compared to those without epilepsy. Epilepsy in older adults was associated with increased odds of in-hospital death (adjusted odds ratio (aOR), 1.55; 95% CI 1.12-2.14, p=0.032), non-routine discharge disposition (aOR, 3.34; 95% CI 2.21-5.03, p<0.001), and longer LOS (46.46% 95% CI 34%-59%, p<0.001). ConclusionsIn models that adjusted for multiple confounders including comorbidity and age, our study found that epilepsy was still associated with higher in-hospital mortality, longer LOS and worse discharge dispositions in older adults with COVID-19 higher in-hospital mortality, longer LOS and worse discharge dispositions in older adults with COVID-19. This work reinforces that epilepsy is a risk factor for worse outcomes in older adults admitted with COVID-19. Timely identification and treatment of COVID-19 in epilepsy may improve outcomes in older people with epilepsy.

Abstract 16776: Recurrent Admission of Acute Decompensated Heart Failure Among Patients With and Without PAD and Its Significance in the CKD Population: The ARIC Cohort Study

Introduction: Peripheral artery disease (PAD) and chronic kidney disease (CKD) are common comorbidities in patients with heart failure (HF). Importantly, CKD is associated with a greater risk of incident PAD and is a known risk factor for worse outcomes in HF patients. However, it is unclear whether the concomitant existence of PAD and CKD increases the risk of recurrent hospitalization for acute decompensated heart failure (ADHF). Methods: Since 2005, the Atherosclerosis Risk in Communities (ARIC) study has conducted hospital surveillance of ADHF with events verified by physician review. Demographics, comorbidities, laboratory data, and medications were abstracted from medical record by trained personnel. Hazard ratios of ADHF readmissions were analyzed using repeat-events Cox regression. Models were adjusted for age, race, sex, year and hospital of admission, coronary artery disease (CAD), COPD, and diabetes mellitus. CKD was defined by glomerular filtration rate [GFR] ≤60 mL/min/1.73m 2 . Results: From 2005-2018, there were 1049 index hospitalizations for ADHF (mean age 77 years, 66% white) with measured creatinine, who were discharged alive. Of these, 155 (15%) had a diagnosis of PAD and 66% had CKD stage 3a or worse (GFR ≤60 mL/min/1.73m 2 ). Patients with PAD had a greater prevalence of smoking, CAD, myocardial infarction, and stroke. The 1-year ADHF readmission rate tended to be higher in patients with PAD, irrespective of CKD stage, compared to those without PAD ( Figure 1 ). After adjustments, PAD was associated with greater hazards of 1-year ADHF readmissions, both in patients with CKD stage 3a or worse (HR, 1.71; 95% CI: 1.25 - 2.32) and without CKD (HR, 1.84; 95% CI: 1.07-3.15). Conclusion: Patients with ADHF and concomitant PAD have a higher prevalence of cardiovascular comorbidities and higher likelihood of 1-year ADHF readmission, irrespective of the CKD status. Focused strategies to prevent ADHF readmission in this high-risk group are warranted.

Abstract 12729: Leadless Pacemaker Insertion is Safe in Nonagenarians

Introduction: Increased age is associated with increased frailty and often worse postoperative outcomes. We aim to assess the safety of leadless pacemaker (LPM) insertion in the very elderly population. Methods: We queried the National Readmission Database years 2017-2020 for patients who underwent LPM insertion with the ICD10 code 02HK3NZ. Patients with age 90 or more were included in the nonagenarians group. Patient comorbidities were queried through the appropriate ICD 10 codes. We compared outcomes using multivariate logistic and linear regression, adjusting for patient comorbidities. Results: At baseline, nonagenarians had a higher prevalence of hypertension, history of stroke, A fib./A. flutter, dementia and hypothyroidism. The control group had more of diabetes, coronary disease, chronic kidney disease, chronic pulmonary disease, oxygen use, coagulopathy, anemia, obesity, substance abuse and chronic liver disease (Table 1). Compared to controls, nonagenarians were found to have shorter length of stay (-2.486 days, p &lt;0.001), lower rate of mortality (aOR 0.696, p 0.0187), lower rates of postprocedural cardiac arrest (aOR 0.301, p 0.0267), mechanical ventilation (aOR 0.378, p &lt;0.001), and vasopressor use (aOR 0.583, p 0.001). Nonagenarians were only found to have increased risk of pericardial complications (tamponade, pericardiocentesis, hemopericardium) (aOR 1.596, p 0.0151). There was no significant difference in 30-day readmissions (aOR 0.97, p 0.696), postoperative bleed (aOR 0.84, p 0.072), or stroke (aOR 0.586, p 0.112). Conclusions: Our study demonstrates LPM insertion is safe in the very elderly population. However this is likely a demonstration of survivorship bias as patients in the nonagenarians group had overall less comorbidities. Even though our analysis adjusted for comorbidities, there are always unknown confounders which cannot be accounted for. Age itself does not seem to be a risk factor for worse outcomes in this population.

COVID-19 and Diabetes Mellitus: Mutual Interplay of Two Diseases.

Currently, when the world is fighting against the rapidly spreading pandemic of COVID-19, the silent epidemic of diabetes should not be set aside. In comparison, while COVID- 19 led to about 6 million deaths in 2021, diabetes caused 6.7 million deaths in the same year. Diabetes mellitus is a serious risk factor for worse outcomes in COVID-19 patients. Moreover, it seems that there is a bidirectional relationship between pre-existing diabetes pandemic and the rapidly spreading COVID-19 pandemic. In this article, we summarize mechanisms by which SARS-CoV-2 infects the host cell and discuss the bidirectional relationship between diabetes and COVID-19. We also focus on clinical variables in which diabetic patients differ from non-diabetic patients and which could have promising predictive value for the course and outcome of diabetic COVID-19 patients' therapy management.

Randomised controlled trial of a behavioural intervention to reduce exposure to PM2.5 in patients with COPD

BackgroundFine particulate matter (PM2.5) is a well-known risk factor for worse outcomes of chronic obstructive pulmonary disease (COPD). However, evidence-based guidance on effective personal behavioural strategies to minimise the effects of PM2.5 is limited. This study aimed to assess the effectiveness of a behavioural intervention in reducing PM2.5 exposure and improving clinical outcomes in patients with COPD. Materials and MethodsParticipants were 1:1 randomised, and the intervention group received a behavioural intervention consisting of five activities, while the control group received usual care. The participants were followed up for 9 months. The primary outcomes were differences in the score of St. George’s Respiratory Questionnaire for patients with COPD (SGRQ-C) and COPD assessment test (CAT) from baseline. ResultsA total of 106 participants were enrolled and 102 completed the study. At the end of the study, the intervention group showed significant improvements in the primary outcomes compared to the control group, with a group difference of −5.9 in the reduction of total SGRQ-C (−3.4 vs. 2.5; p = 0.049) and −3.8 in the CAT score (−1.2 vs. 2.7; p = 0.001). Participants with good adherence to the intervention demonstrated a greater extent of improvement in CAT score and lower PM2.5 levels compared to those who had poor adherence or were in the control group. Regular checking of air quality forecasts was significantly associated with a reduction in CAT scores among all the intervention activities. ConclusionIndividual-level behavioural interventions can be an effective strategy for mitigating the health hazards associated with PM2.5.ClinicalTrials.gov Identifier: NCT04878367.

FRI043 The Double Pandemic Effect Of Obesity And COVID-19 Among United States Adult Hospitalizations: Outlining Hospitalization Outcomes Of A Synergistic Catastrophe

Abstract Disclosure: H. Shaka: None. A. Ilelaboye: None. E. Krishnaraju: None. M. Dasgupta: None. A. Shaka: None. P. Kanemo: None. Introduction: The COVID-19 pandemic exacerbated significant health disparities among adults in the US. Obesity has been on the rise in the US for decades and has been described as a pandemic. Morbid obesity (MO) is a known risk factor for worse outcomes for viral pneumonia including SARS-CoV-2. This study outlined the national impact of the COVID-19 pandemic on the ongoing obesity pandemic and assessed possible healthcare disparities in this population. Methods: The study obtained data from the US National Inpatient Sample from 2016 - 2020. This provides a nationally representative estimate of all US hospitalizations for each calendar year. We assessed rates of MO hospitalizations per 1000 adult hospitalizations yearly. We compared outcomes between 2019 and 2020 to evaluate the COVID-19 pandemic's effect on this population. Outcomes were also stratified by sex, race, and median household income. Results: From 2016 to 2020, hospitalizations involving adults with MO increased by 61%. While national hospitalizations dropped by about 9% in 2020, those involving adults with MO increased by 7.1% compared with 2019 adjusted for age, race, sex, and comorbidity index. In 2020, hospitalized adults with MO had a lower mean age and a higher proportion of men compared to 2019. There was no significant difference in the race, income and comorbidity index distribution of the patients in 2020 compared to 2019. Among adults with MO who died during hospitalization in 2020, about 1 in 5 had COVID-19 as the reason for admission. The mortality rate in all adults with MO increased from 1.5 to 2.7%. This represented an 84.5% higher odds of mortality compared to 2019. Stratification showed that there was an 80.0 vs 88.9% higher mortality in females vs males. Mortality in Hispanics increased by 169.7%, compared to 111.7% in Blacks and 66.8% in Whites. Patients in the lowest income quartile had an increase of 97.2 vs 61.7% in the highest income quartile. There were also significant regional variations in the increase in mortality among hospitalizations with MO. Year on year, total hospitalization charges in the studied population increased by $10 billion to over $156 billion, adjusted for inflation. The year 2020 also saw an overall increase in the length of hospitalizations for adults with MO. Discussion/conclusion: This study provides evidence that at the national level, patients with MO were significantly impacted by the COVID-19 pandemic. This contributed to significant healthcare costs. We recommend a national approach and response to the obesity pandemic as people with morbid obesity are projected to make up to 30% of the US population by 2030. We also highlighted significant racial and economic disparities in the outcomes of these patients. Although the reasons for such disparities are likely multifactorial, this adds to a growing body of evidence of disparities in healthcare across various health conditions. Presentation: Friday, June 16, 2023

THU541 Impact Of Gender On Treatment Decisions And Outcome In Patients With Neuroendocrine Neoplasms

Abstract Disclosure: J. Beck: None. A. Siebenhüner: None. D. Wild: None. E.R. Christ: None. J. Refardt: None. Introduction/Background: Gender differences affect the treatment of several diseases in both male and female patients. However, the influence of gender on treatment decisions and outcome in neuroendocrine neoplasms (NENs) has scarcely been investigated. Aims: Comparison of tumor characteristics, treatment decisions and outcome of patients with NENs, stratified by gender. Material and Methods: Retrospective analysis of the SwissNET cohort involving NENs of gastroenteropancreatic, pulmonal or unknown origin from 07/14 – 09/21. Site of origin, tumor grading, time to first treatment, choice of treatment and overall survival was assessed. Results: 2329 patients were included in the analysis with 54% being male and 46% female patients. No significant difference in site of origin, tumor grading and staging was found between male and female patients. There was also no difference in time of symptoms onset until diagnosis and first treatment intervention. Surgery was performed in 66.3% of male and 71% of the female patients, p=0.016. Meanwhile, male patients received more often PRRT (22% vs 19.3%, p=0.007) and chemotherapy (15.9% vs 12.7%, p=0.032). Despite the similar tumor characteristics, the median overall survival of male patients was significantly lower compared to female patients (Male: 124.8 months, Female: 158.5 months, p&amp;lt;0.001). Interestingly, this difference was most pronounced in patients with lung NENs (Male: 142 months, Female: not reached) and cancer of unknown origin (Male: 18.5 months, Female: 35 months). Conclusions: Male gender seems to be a risk factor for worse outcome, specifically for lung NENs and NENs of unknown origin. The underlying mechanisms of these findings remain to be established. Presentation: Thursday, June 15, 2023

THU322 Lower HbA1c Is Associated With Lower In-Hospital Mortality In Patients With COVID-19

Abstract Disclosure: M. Tsikala Vafea: None. M. Stefanovic-Racic: None. Introduction/Aim: Diabetes has been proven to be a risk factor for worse outcomes in patients with COVID-19. Several studies have shown that poor glycemic control during hospitalization with COVID-19 is associated with higher mortality. However, the association between a long-term glycemic control and outcomes has yet to be clarified, with some studies reporting no association. The aim of this study is to determine the association between glycosylated hemoglobin (HbA1c) and in-hospital mortality in patients with COVID-19. Methods: Pubmed, Embase and Web of Science databases were searched until 11/15/2022, for studies examining the association between HbA1c level and mortality in hospitalized patients with COVID-19. A random-effects meta-analysis was performed. Heterogeneity was assessed using the I2 statistic. Publication bias was assessed using funnel plots. Results: Among 4,142 results, 22 studies were included in the final analysis with a total of 11,998 patients. In the primary analysis, in studies comparing outcomes in patients using HbA1c as a dichotomous variable using specific cutoff values, lower Hba1c was associated with lower in-hospital mortality [odds ratio (OR) 0.52, 95% confidence interval (CI) 0.37-0.72]. Heterogeneity was substantial (I2 78%). When only patients with diabetes were included in the analysis, the association remained statistically significant (OR 0.70, 95% CI 0.51-0.98). In the subgroup analysis, the association remained statistically significant in studies using as cutoff the HbA1c value of 6.5% (OR 0.34, 95% CI 0.15-0.77) and 7% (OR 0.54, 95% CI 0.32-0.90). The association did not remain statistically significant with greater HbA1c cutoff values; 7.5% (OR 1.09, 95% CI 0.91-1.30) and &amp;gt;= 8% (OR 0.78, 95% CI 0.33-1.82). In the secondary analysis, in studies using HbA1C as a continuous variable, HbA1c level did not have a statistically significant association with in-hospital mortality, either in univariate (OR 0.97, 95% CI 0.92-1.03) or multivariate analyses (adjusted OR 1.00, 95% CI 1.00-1.01). Conclusion: A better glycemic control prior to hospitalization, as reflected by lower HbA1c, is associated with lower in-hospital mortality in patients with COVID-19. Presentation: Thursday, June 15, 2023

COVID-19 and diabetes

Almost immediately after the emergence of the SARS-CoV-2 coronavirus, it was observed that people with chronic diseases, including diabetes, presented an increased risk of hospitalization and mortality. Diabetes can increase the risk of COVID-associated mortality by more than six times. The hypothesis of a bidirectional relationship between COVID-19 and diabetes assumes that diabetes is a risk factor for worse outcomes of COVID-19 treatment and that coronavirus infection is a predisposing factor for newly diagnosed diabetes or hyperglycemic emergencies. New diagnoses or exacerbations of existing diabetes are associated with direct damage to the pancreas or the body's response to chronic inflammation, and ACE receptors play a large role in this pathomechanism. Restrictions implemented in many countries have resulted in poorer control and underdiagnosis of diabetes. In this review, we summarize the impact of acute COVID-19 on people with diabetes, discuss how presentation and epidemiology changed during the pandemic, and consider the broader impact of the pandemic on patients and healthcare delivery.