Risk Factors For 1-year Mortality Research Articles

Sarcopenia is an independent risk factor for short-term mortality in patients undergoing transjugular intrahepatic portosystemic shunt.

Sarcopenia is common in patients with cirrhosis and is a risk factor for increased mortality. Transjugular intrahepatic portosystemic shunt (TIPS) placement has been utilized in cirrhosis patients with decompensation. We investigated the role of sarcopenia in predicting mortality in patients undergoing TIPS. We conducted a single-center retrospective study of 232 patients with cirrhosis who underwent TIPS between January 2010 and December 2015. Sarcopenia was defined by the psoas muscle index (PMI) cutoff value, calculated based on dynamic time-dependent outcomes using X-tile software. Kaplan-Meier analysis demonstrated the difference in survival in the sarcopenia group versus the non-sarcopenia group. . Univariate and multivariate analyses were used to identify the relationship between sarcopenia and post-TIPS mortality during a follow-up period of 1 year. For TIPS indications, 111 (47.84%) patients had refractory ascites, 69 (29.74%) patients had variceal bleeding, 12 (5.17%) patients had ascites, and 40 (17.24%) for other indications. The mean PMI was 4.40 ± 1.55. Sarcopenia was defined as a PMI value of <4.36 in males, and <3.23 in females. Sarcopenia was present in 96 (41.38%) of patients. . Kaplan-Meier analysis showed thatsarcopenia is associated with worse survival (log-rank P < 0.01). Multivariate Cox regression analysis showed that sarcopenia is independently associated with worse survival during the 1-year follow-up period with an hazard ratio of 2.435 (95% CI 1.346-4.403) (P < 0.01), after adjusting for age, BMI, indications for TIPS, etiology for cirrhosis, and MELD score and stratified by sex. Sarcopenia is an independent risk factor for 1-year mortality in patients undergoing TIPS and should be considered when patients are evaluated as a candidate for TIPS.

Preoperative Risk Factors for 1-year Mortality in Patients Undergoing Fenestrated Endovascular Aortic Aneurysm Repair in the US-Aortic Research Consortium

BackgroundEarly survival (1-year) following elective repair of complex abdominal aortic aneurysms (AAA) or thoracoabdominal aortic aneurysms (TAAA) can be utilized as an indicator of successful repair and provides a reasonable countermeasure to the annual rupture risk based on diameter. We aimed to identify preoperative factors associated with 1-year mortality following F/BEVAR and develop a predictive model for 1-year mortality based on patient-specific risk-profiles. MethodsThe US-Aortic Research Consortium (US-ARC) database was queried for all patients undergoing elective F/BEVAR for complex AAA or TAAA from 2005-2022. The primary outcome was 1-year survival based on preoperative risk-profile. Multivariable Cox regression was used to determine preoperative variables associated with 1-year mortality overall and by extent of aortic pathology. Logistic regression was performed to build a predictive model for 1-year mortality based on number of risk factors present. ResultsA total of 2,099 patients met the inclusion criteria for this study (complex AAA: N=709, 34.3%; Type 1-3 TAAA: N=777, 37.6%; Type 4-5 TAAA: N=580, 28.1%). Multivariable Cox regression identified the following significant risk factors associated with 1-year mortality: current smoker, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), Aortic diameter>7cm, Age>75, Extent 1-3, creatinine>1.7mg/dL, and hematocrit<36%. When stratified by extent of aortic involvement, multivariable Cox regression revealed risk factors for 1-year mortality in complex AAA (CHF max aortic diameter>7cm, hematocrit<36mg/dL, and current smoking status), Type 1-3 TAAA (COPD, CHF, and Age>75) and Type 4-5 TAAA (age>75, creatinine>1.7mg/dL, and hematocrit<36mg/dL). Logistic regression was then utilized to develop a predictive model for 1-year mortality based on patient risk-profile. Appraisal of the model revealed an area under the curve of 0.64, p-value<0.001, and observed to expected ratio of 0.85. ConclusionsThis study describes multiple risk factors associated with an increase in 1-year mortality following F/BEVAR. Given that elective repair of complex AAA or TAAA is offered to some patients in whom future rupture risk outweighs operative risk, these findings suggest that highly comorbid patients with smaller aneurysms may not benefit from repair. Descriptive and predictive models for 1-year mortality based on patient risk-profiles can serve as an adjunct in clinical decision-making when considering elective F/BEVAR.

Therapy aspects of peri-implant femoral fractures-a retrospective analysis of 64 patients.

The incidence of peri-implant femoral fractures (PIFF) is increasing. Information regarding outcomes, timing of surgery, risk factors, and a clinically applicable treatment algorithm are lacking. The aim of this study was to identify outcome-related risk factors and to derive a treatment algorithm. Sixty-four PIFFs treated between 01.01.2006 and 31.12.2020 in a level I trauma centre were evaluated retrospectively for fracture pattern, surgical technique, risk factors, complications, and 1-year mortality. The study was approved by the ethics committee (No. 21-2714-104). One-year mortality was 24.1%. Surgical complications occurred in 4.7%, and general complications in 15.6% of the patients. General complications, low haemoglobin level at admission, elevated CHA2DS2-VASc, and Charlson score resulted in increased 1-year mortality. Time to surgery > 24h did not increase complication or mortality rates. The three predominant fracture patterns were fractures close or distal to cephalomedullary nails, close or proximal to distal lateral plates, and close or distal to sliding hip screws. Recommendations for surgical treatment were derived: Osteosynthesis should enable as much weight-bearing as possible; the initial implant should only be removed, if this is essential for the new osteosynthesis; lateral locking plates should span the whole femur; antegrade nails should have a cephalomedullary component to avoid consecutive femoral neck fractures; implants should overlap to reduce the risk of consecutive inter-implant fractures. Risk factors for 1-year mortality in patients with PIFFs were identified. A treatment algorithm and general principles for surgery of PIFFs were developed.

Outcome and microbiological findings of patients with cardiac implantable electronic device infection.

Infections associated with cardiac implantable electronic devices (CIEDs) are a multifactorial disease that leads to increased morbidity and mortality. The aim was to analyze patient-, disease- and treatment-related characteristics including microbiological and bacterial spectrum according to survival status and to identify risk factors for 1- and 3-year mortality in patients with local and systemic CIED infection. In a retrospective cohort study, we analyzed data from patients with CIED-related local or systemic infection undergoing successful transvenous lead extraction (TLE). Survival status as well as incidence and cause of rehospitalization were recorded. Microbiology and antibiotics used as first-line therapy were compared according to mortality. Independent risk factors for 1- and 3-year mortality were determined. Data from 243 Patients were analyzed. In-hospital mortality was 2.5%. Mortality rates at 30days, 1- and 3years were 4.1%, 18.1% and 30%, respectively. Seventy-four (30.5%) patients had systemic bacterial infection. Independent risk factors for 1-year mortality included age (OR 1.05 [1.01-1.10], p = 0.014), NT-proBNP at admission (OR 4.18 [1.81-9.65], p = 0.001), new onset or worsened tricuspid regurgitation after TLE (OR 6.04 [1.58-23.02], p = 0.009), and systemic infection (OR 2.76 [1.08-7.03], p = 0.034), whereas systemic infection was no longer an independent risk factor for 3-year mortality. Staphylococcus aureus was found in 18.1% of patients who survived and in 25% of those who died, p = 0.092. There was a high proportion of methicillin-resistant strains among coagulase-negative staphylococci (16.5%) compared to Staphylococcus aureus (1.2%). Staphylococci are the most common causative germs of CIED-infection with coagulase-negative staphylococci showing higher resistance rates to antibiotics. The independent risk factors for increased long-term mortality could contribute to individual risk stratification and well-founded treatment decisions in clinical routine. Especially the role of tricuspid regurgitation as a complication after TLE should be investigated in future studies.

Surgical treatment of displaced proximal humerus fractures is associated with decreased 1-year mortality in patients aged 65 years and older: a retrospective study of Medicare patients

BackgroundProximal humerus fracture (PHF) is a risk factor for 1-year mortality. This study aimed to determine if surgery is associated with lower mortality compared to nonoperative treatment following PHF in older patients. MethodsThis retrospective cohort study used the Medicare Limited Data Set. Patients aged 65+ with a PHF diagnosis in 2017-2020 were included. Treatment was classified as nonoperative, open reduction internal fixation (ORIF), total shoulder arthroplasty (TSA), or hemiarthroplasty. Multivariable logistic regression models examined (a) predictors of treatment type and (b) the association of treatment type with 1-year mortality, adjusting for patient demographics, comorbidities, frailty, and fracture severity among other variables. A subgroup analysis examined how the relationship between treatment type and 1-year mortality varied based on fracture severity. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) are reported. ResultsIn total, 49,072 patients were included (mean age = 76.6 years, 82.3% female). Most were treated nonoperatively (77.5%), 10.9% underwent ORIF, 10.6% underwent TSA, and 1.0% underwent hemiarthroplasty. Examples of factors associated with receipt of operative (versus nonoperative treatment) included worse fracture severity and lower frailty. The 1-year mortality rate after the initial PHF diagnosis was 11.0% for the nonoperative group, 4.0% for ORIF, 5.2% for TSA, and 6.0% for hemiarthroplasty. Compared to nonoperative treatment, ORIF (aOR 0.55; 95% CI [0.47, 0.64]; P<.001) and TSA (aOR 0.59; 95% CI [0.50, 0.68]; P<.001) were associated with decreased odds of 1-year mortality. In the subgroup analysis, ORIF and TSA were associated with a lower 1-year mortality risk for 2-part and 3-/4-part fractures. ConclusionsCompared to nonoperative treatment, surgery (particularly TSA and ORIF) was associated with a decreased odds of 1-year mortality. This relationship remained significant for 2-part and 3-/4-part fractures after stratifying by fracture severity.

The association between sarcopenia, defined by a simplified screening tool, and long-term outcomes.

Sarcopenia and frailty are frequently observed in older adult patients and linked to unfavorable postoperative outcomes. Identifying low muscle mass and function is primary for diagnosing sarcopenia. The simpler screening, which excludes muscle mass measurement, exhibited strong predictive capabilities in identifying sarcopenia. This research explored the association between sarcopenia, as defined by the C3 formula, and long-term outcomes in older adult cancer patients who underwent surgery. Surgical cancer patients aged 60 and older were enrolled. Sarcopenia was identified using the C3 formula, assessing muscle strength through handgrip strength, physical performance via a 6-m walk test, and nutrition status via the Mini Nutritional Assessment-Short Form. Long-term outcomes were evaluated with the Barthel Index for activities of daily living (B-ADL) at 3 months, as well as 1-year mortality rates. The study enrolled 251 patients, with 130 classified as sarcopenic according to the C3 formula. Compared with nonsarcopenic patients, patients with sarcopenia exhibited a higher frequency of moderate to severe disability (B-ADL ≤70) 3 months postdischarge (19.5% vs 5.2%; P = 0.001) and elevated 1-year mortality rates (29.5% vs 14.9%; P = 0.006). No significant differences were observed in infection rates, hospital stay duration, or in-hospital mortality. Distant organ metastasis (HR = 3.99; 95% CI = 2.25-7.07) and sarcopenia defined by the C3 formula (HR = 1.78; 95% CI = 1.01-3.15) were identified as independent risk factors for 1-year mortality. The simplified sarcopenia screening tool was associated with increased rates of moderate to severe disability 3 months postdischarge and higher 1-year mortality rates compared with nonsarcopenic patients.

Predictors of 1-year mortality after gastrectomy for gastric cancer.

One-year mortality is important for referrals to specialist palliative care or advance care planning (ACP). This helps optimize comfort for those who cannot be cured or have a lower life expectancy. Few studies have investigated the risk factors for 1-year mortality after gastrectomy for gastric cancer (GC). A total of 1415 patients with gastric cancer (stages I-IV) who underwent gastrectomy between 2005 and 2020 were included. The patients were randomly assigned to the investigation group (n=850) and validation group (n=565) in a 3:2 ratio. In the investigation group, significant independent prognostic factors for predicting 1-year survival were identified. A scoring system for predicting 1-year mortality was developed which was validated in the validation group. Multivariate analysis revealed that the following seven variables were significant independent factors for 1-year survival: age ≧78, preoperative comorbidity, total gastrectomy, postoperative complication (Clavien-Dindo classification CD≧3a), stage III and IV, and R2 resection. While developing a 1-year mortality score (OMS), an age ≧78 was scored 2, preoperative comorbidity, total gastrectomy, and postoperative complication (CD≧3a) were scored 1, and stage III, IV, and R2-resection were scored 2, 3, and 3, respectively. OMS 3 had a sensitivity of 91% and a specificity of 66% for predicting death within 1year. In the validation group, OMS 5 had a sensitivity of 55% and a specificity of 93% for predicting death within 1year. OMS may provide important information and help surgeons select the timing of ACP in patients with GC.

Transition from temporary microaxial left ventricular assist devices to durable mechanical circulatory support systems

Abstract Background Circulatory support with a catheter-based microaxial temporary left ventricular assist device (tLVAD) plays a major role in the treatment of severe cardiogenic shock. In most patients who fail to recover while on temporary mechanical circulatory support (tMCS), durable left ventricular assist device (dLVAD) therapy is usually considered a reliable option. The aim of this study was to identify outcome predictors after the transition from a catheter-based microaxial tLVAD to dLVAD. Methods This is a retrospective analysis of data from a multicentre registry on patients who were transitioned from a catheter-based microaxial tLVAD to a dLVAD between 01/2017 and 10/2022 (n=341) from 19 European high-volume centres with regard to survival and outcome up to one year after dLVAD implantation. Results Patients were supported with an Impella 5.5 (92), 5.0 (155), CP (92), or 2.5 (2) and transitioned to Heartmate 3 (205), a HeartWare HVAD (129) or EXCOR VAD (7) during the same period. The Impella was implanted via the axillary artery in 245 (71.8%), the femoral artery in 93 (27.3%), and via direct access to the aorta in three (0.9%) patients. One hundred and thirty-three (40.5%) patients additionally required extracorporeal life support before and/or during Impella therapy. The aetiology of cardiogenic shock necessitating tMCS was most commonly acute myocardial infarction (31.7%), followed by acute decompensation of ischaemic (28.4%) or dilated cardiomyopathy (27.0%). The 30-day and 1-year survival were 87% and 70%, respectively. The uni- and multivariable analysis included 312 patients with an at least 1-year follow-up or death within the first year after dLVAD implantation. The following risk factors for 1-year mortality were identified: age (OR 1.02), specifically age over 55 years (OR 1.09), BMI &amp;gt;30 kg/m² (OR 2.2), female sex (OR for male sex 0.4), as well as elevated total bilirubin (OR 1.13) and low platelet counts (OR 0.996). Conclusions During preoperative conditioning, efforts should be undertaken towards normalising platelet counts and liver function. Using the identified risk factors as a basis, we created a risk score to estimate 1-year mortality to optimise patient selection for dLVAD implantation, with the aim of improving the outcome in this critical patient population.Normogram 1y-mortality prediction scoreCIF death grouped by quartiles of score

Impact of Chronic Kidney Disease and Dialysis on Outcome after Surgery for Infective Endocarditis.

Infective endocarditis (IE) carries a heavy burden of morbidity and mortality in chronic kidney disease (CKD) and hemodialysis (HD) patients. We investigated the risk factors, pathognomonic profile and outcomes of surgically treated IE in CKD and HD patients. We preoperatively identified patients with CKD under hemodialysis (HD group) and compared them with patients without hemodialysis (Non-HD group). Furthermore, we divided the cohort into four groups according to the underlying stage of CKD, with a subsequent outcome analysis. Between 2009 and 2018, 534 Non-HD and 58 HD patients underwent surgery for IE at our institution. The median age was 65.1 [50.6-73.6] and 63.2 [53.4-72.8] years in the Non-HD and HD groups, respectively (p = 0.861). The median EuroSCORE II was 8.0 [5.0-10.0] vs. 9.5 [7.0-12.0] in the Non-HD vs. HD groups (p = 0.004). Patients without CKD had a mortality rate of 5.6% at 30 days and 15.5% at 1 year. Mortality rates proportionally rose with the severity of CKD. Among HD patients, 30-day and 1-year mortality rates were 38.1% and 75.6%, respectively (p < 0.001). Staphylococcus aureus IE was significantly more frequent in the HD group (p = 0.006). In conclusion, outcomes after surgery for IE correlated with the severity of the underlying CKD, with HD patients exhibiting the most unfavorable results. Pre-existing CKD and staphylococcus aureus infection were independent risk factors for 1-year mortality.

CRP/albumin ratio in predicting 1-year mortality in elderly patients undergoing hip fracture surgery.

In the literature, rates of up to 37.1% have been reported for 1-year mortality after hip fractures. In this study, we aimed to determine whether the C-reactive protein/albumin ratio (CAR) is an independent risk factor for 1-year mortality after hip fracture and whether CAR, neutrophil/lymphocyte ratio (NLR), CRP, albumin level, and other parameters have an effect on mortality and morbidity. Over a 3-year period, 480 patients aged 65 years and older who underwent hemiarthroplasty for hip fracture were analyzed. A univariate logistic regression analysis was performed to identify prognostic factors for 1-year mortality. Significant variables were re-evaluated using binary logistic regression analysis. The number of patients who died within 1 year postoperatively was 95 (27.7%), and the median age was 85 years. In the receiver operating characteristic analysis (ROC) for 1-year mortality after hip fracture, the optimal cut-off value of CAR was found to be 1.03. The area under the curve (AUC) for mortality was 0.843, the sensitivity was 65.3%, and the specificity was 92.7% [95% confidence interval (CI), 0.791-0.895; p < 0.001]. The optimal cut-off value for CRP was 2.85, the AUC was 0.838, the sensitivity was 70%, and the specificity was 89% (95% CI, 0.785-0.890; p < 0.001). The optimal cut-off value of NLR for postoperative intensive care unit (ICU) admission was determined to be 6.64. CAR was a predictive factor for 1-year postoperative mortality and postoperative ICU admission, whereas NLR was a predictive factor for postoperative ICU admission.

The impact of malperfusion patterns in elderly patients undergoing surgery for acute type A aortic dissection.

The aim of this study is to investigate the outcome of elderly patients with surgically treated acute type A aortic dissection (ATAAD) complicated by malperfusion. Patients ≥70 years old who underwent surgical treatment for ATAAD between January 2000 and December 2020 were enrolled in this study and stratified by their specific Penn Classification into 4 different subgroups, where Penn Abc was defined as multilevel malperfusion. Short- and long-term outcomes were investigated. Multivariable binary logistic regression was performed to identify risk factors for 1-year mortality. Four hundred elderly patients underwent surgical treatment for ATAAD. A total of 204 (51%) patients had no evidence of malperfusion (Penn Aa), 106 (26.5%) had localized organic malperfusion (Penn Ab), 44 (11%) patients had systemic malperfusion (Penn Ac) and 46 (11.5%) suffered from multilevel malperfusion (Penn Abc). For the latter, in-hospital mortality was 70% (P < 0.001). Age (P < 0.006) and multilevel malperfusion (P < 0.001) were independent risk factors for 1-year mortality. Patients with multilevel malperfusion showed the worst 1-year survival (P < 0.001). In the case of Penn Aa, in-hospital mortality was 13% (P < 0.001). Surgery may lead to satisfactory results in the absence of malperfusion, even in octogenarians. Elderly patients with multilevel malperfusion show very poor surgical outcome. In these patients, the decision for surgery should be taken with caution. Operation, if performed, should be carried out by experienced teams only.

Risk Factors for 1-Year Mortality After Heart Transplant in Obese Patients Bridged With an LVAD

BackgroundHeart transplantation is relatively contraindicated in morbidly obese patients because of increased morbidity and mortality. This study identified risk factors for post–heart transplantation mortality in obese patients with a left ventricular assist device (LVAD). MethodsThe United Network for Organ Sharing database was used to identify patients with a body mass index ≥35 kg/m2 who had a durable LVAD at the time of isolated heart transplantation between 2010 and 2021. The primary outcome was post–heart transplantation 1-year mortality. Multivariable Cox regression modeling was used to identify significant risk factors for 1-year mortality. Receiver-operating characteristic analyses were performed to identify optimal thresholds for continuous variables associated with the primary outcome. Patients were stratified by the number of risk factors, and Kaplan-Meier analysis was used to compare survival. ResultsA total of 1222 obese patients were bridged to heart transplantation with a durable LVAD. Six risk factors were identified as significantly associated with 1-year post–heart transplantation mortality: recipient age >62.5 years, body mass index >36.6 kg/m2, bilirubin level >0.95 mg/dL, cold ischemic time >3.7 hours, recipient-donor sex mismatch, and pretransplantation mechanical ventilation. The distribution of cumulative risk factors was as follows: 8.6% with 0, 30.6% with 1, 37.0% with 2, and 23.8% patients with ≥3 risk factors. The 1-year survival rate decreased significantly from 96.0% in those patients with 0 risk factors to 77.6% in those with 3 or more risk factors. ConclusionsThese data provide a useful guide for risk stratification and patient selection in obese LVAD candidates being considered for heart transplantation.

A new simplified cardiac damage staging for aortic stenosis: the role of longitudinal global strain and right ventricular arterial coupling

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Transcatheter aortic valve replacement (TAVR) continues to evolve as a treatment for patients with severe aortic stenosis (AS) in different clinical scenarios. As aortic valve disease progresses, secondary cardiac damage sets in; this damage is not always reversible and determines the prognosis by itself. Concerning extra-valvular repercussions, different staging systems of cardiac damage have been published and proposed as a prognostic tool that may help to improve the selection of candidates to TAVR. Purpose The aims of our study were to identify independent risk factors for 1-year mortality in patients with severe AS undergoing TAVR and to develop a new cardiac damage staging system to stratify these patients. Methods patients undergoing TAVR from 2017 to 2021 were included in a single-center prospective registry. Transthoracic echocardiography was performed in all patients before TAVR. Logistic regression analysis and Cox’s regression were used to identify predictors of 1-year all-cause mortality. Applying variables from the regression analyses, a new staging model was proposed. The area under the ROC curve (AUC ROC) was used to measure the discriminatory capacity of different staging models to predict 1-year mortality risk. Results 496 patients (mean age 81.9±6.2 years, 67% men) were included. 1-year mortality in our population was 22.3% (n= 111). Left ventricle ejection fraction (LVEF), moderate mitral regurgitation (MR), severe tricuspid regurgitation (TR), and right ventricular-arterial coupling (RVAc) were found to be independent predictors of all-cause 1-year mortality. A new classification system with three different stages was developed: Stage 0) No cardiac damage: LVEF ≥ 60%; left ventricle global longitudinal strain (LV-GLS) &amp;lt; −15%, RVAc ≥ 0.35 and absence of MR. Stage 1) Left side subclinical damage: LVEF 50–59.9% or LV-GLS ≥ −15% or presence of moderate or severe MR. Stage 2) Left or right ventricular damage: LVEF &amp;lt; 50% or RVAc &amp;lt; 0.35. The area under the ROC curve for this model was 0.67 (95% confidence interval 0.60–0.73), and its predictive performance was superior compared to the previously published systems (p = 0.009). A stepwise increase in 1-year all-cause mortality for each category increment in this new cardiac staging system was found. Conclusion Cardiac damage staging might have an important role in patients’ selection and better timing for TAVR. A model that includes new parameters, such as LV GLS and RVAc, may help to both improve prognostic stratification and contribute to better selection and earlier programming of TAVR.

Redefining cardiac damage staging in aortic stenosis: the value of GLS and RVAc.

Cardiac damage staging has been postulated as a prognostic tool in patients undergoing transcatheter aortic valve replacement (TAVR). The aims of our study are (i) to validate cardiac damage staging systems previously described to stratify patients with aortic stenosis (AS), (ii) to identify independent risk factors for 1-year mortality in patients with severe AS undergoing TAVR, and (iii) to develop a novel staging model and compare its predictive performance to that of the above mentioned. Patients undergoing TAVR from 2017 to 2021 were included in a single-centre prospective registry. Transthoracic echocardiography was performed in all patients before TAVR. Logistic and Cox's regression analysis were used to identify predictors of 1-year all-cause mortality. In addition, patients were classified based on previously published cardiac damage staging systems, and the predictive performance of the different scores was measured.Four hundred and ninety-six patients (mean age 82.1 ± 5.9 years, 53% female) were included. Mitral regurgitation (MR), left ventricle global longitudinal strain (LV-GLS) and right ventricular-arterial coupling (RVAc) were independent predictors of all-cause 1-year mortality. A new classification system with four different stages was developed using LV-GLS, MR, and RVAc. The area under the receiver operating characteristic curve was 0.66 (95% confidence interval 0.63-0.76), and its predictive performance was superior compared with the previously published systems (P < 0.001). Cardiac damage staging might have an important role in patients' selection and better timing for TAVR. A model that includes LV-GLS, MR, and RVAc may help to improve prognostic stratification and contribute to better selection of patients undergoing TAVR.

Incidence of Invasive Infections Among Hemato-Oncology Patients with Significant Burden of Candida in Stool.

Candidemia is a serious infection associated with increased mortality. It is unclear whether a high concentration of Candida in stool in patients with hematologic malignancies is associated with a higher risk for developing candidemia. In this observational historical study in patients hospitalized in hemato-oncology departments, we describe the association between gastrointestinal Candida colonization and the risk for candidemia and other severe outcomes. Data from 166 patients with heavy burden of Candida in stool were collected and compared to a control group of 309 patients with minimal or no Candida in stool, from 2005 to 2020. Severe immunosuppression and recent use of antibiotics were more common in heavily colonized patients. Outcomes of heavily colonized patients were worse as compared to the control group with statistical significance in 1-year mortality (53% vs. 37.5%, p = 0.001) and borderline statistical significance in candidemia rate (12.6% vs. 7.1%, p = 0.07). Risk factors for 1-year mortality were significant colonization of Candida in stool, older age and recent use of antibiotics. In conclusion, significant stool burden of Candida among hospitalized hemato-oncology patients may pose a risk for 1-year mortality and increased candidemia rate.

Trends in Cardiovascular Surgery in South Korea: A Nationwide Cohort Study from 2010 to 2019

We aimed to investigate mortality and its associated factors in cardiovascular surgery-associated intensive care unit (ICU) admissions in South Korea from 2010 to 2019. Population-based cohort study. Data from the National Health Insurance Service database in South Korea were used in this study. All adult patients admitted to the ICU associated with cardiovascular surgery in South Korea between January 1, 2010 and December 31, 2019 were analyzed. None. A total of 62,794 ICU admissions associated with cardiovascular surgery were included in the analysis (median value of age: 65 years; 58.0% men). This included patients who underwent coronary artery bypass grafting (CABG) only (n=10,704), valve-only surgery (n=35,812), CABG+valve surgery (n=3,230), aortic procedures (n=7,968), and others (n=5,080). The number of cardiovascular surgeries associated with ICU admissions was 4,409 in 2010, which gradually increased to 10,366 in 2019. The aortic procedure group had the highest 1-year mortality rate after cardiovascular surgery (15.7%), followed by the CABG+valve (13.2%), others (11.5%), CABG-only (9.5%), and valve-only (8.7%) groups. Invasive life support procedures during the ICU stay and hospital admission through the emergency room were potential risk factors for 1-year mortality after cardiovascular surgery. Cardiovascular surgery-associated intensive care admissions gradually increased from 2010 to 2019 in South Korea. Among these patients, the highest 1-year mortality rate was observed in the aortic procedures group, followed by the CABG+valve, others, CABG-only, and valve-only groups.

Serum Ionized Calcium as a Prognostic Biomarker in Type B Aortic Dissection After Endovascular Treatment.

Lower serum ionized calcium (iCa2+) was reported to be associated with a higher risk of adverse events in patients with cardiovascular diseases. This study aimed to investigate the associations between preoperative serum iCa2+ and outcomes of type B aortic dissection (TBAD) patients receiving thoracic endovascular aortic repair (TEVAR). Between January 2016 and December 2019, 491 TBAD patients received TEVAR in a single center. Patients with acute or subacute TBAD were included. Serum iCa2+ (pH 7.4) was obtained from the arterial blood gas analysis before TEVAR. The study population was grouped into the hi-Ca group (1.11 mmol/L ≤ iCa2+ < 1.35 mmol/L) and lo-Ca group (iCa2+ < 1.11 mmol/L). The primary outcomes were all-cause mortality. The secondary outcomes were any major adverse clinical events (MACEs), which included all-cause mortality and aortic-related severe complications. To eliminate bias, 1:1 propensity score matching (PSM) was conducted. Overall, 396 TBAD patients were included in this study. In the total population, there were 119 (30.1%) patients in the lo-Ca group. After PSM, 77 matched pairs were obtained for further analysis. In the matched population, the 30-day mortality and 30-day MACEs between the two groups presented significant differences (p=0.023 and 0.029, respectively). At 5 years, cumulative incidences of mortality (log-rank p<0.001) and MACEs (log-rank p=0.016) were significantly higher in the lo-Ca group than that of the hi-Ca group. Multivariate cox regression analysis indicated that lower preoperative iCa2+ (hazard ratio for per 0.1 mmol/L decrease, 2.191; 95% confidence interval, 1.487-3.228, p<0.001) was an independent risk factor for 5-year mortality after PSM. Lower preoperative serum iCa2+ might have an association with 5-year mortality in TBAD patients after TEVAR. Serum iCa2+ monitoring in this population may facilitate the identification of critical conditions. Our present study found that the cutoff value of preoperative serum iCa2+ 1.11 mmol/L, which is slightly lower than the lower limit of the normal range of 1.15-1.35 mmol/L, worked relatively well for discerning the high-risk and low-risk TBAD patients at 5 years. Serum iCa2+ monitoring in TBAD patients receiving TEVAR may facilitate the identification of critical conditions.

Outcomes of geriatric periprosthetic distal femur fractures: comparison of fixation versus reconstruction.

Comparing outcomes of periprosthetic distal femur fractures treated with open reduction internal fixation (ORIF) versus distal femoral replacement (DFR). Three major academic hospitals within one metropolitan area. Retrospective. 370 patients >64 years old with periprosthetic distal femur fractures were identified and 115 were included (65 ORIF vs 50 DFR). ORIF with locked plating versus DFR. One-year mortality, ambulatory status at 1 year, reoperations, and hospital readmissions. No differences were seen between ORIF and DFR cohorts with respect to demographics or medical history, including Charleston Comorbidity Index. DFR was associated with longer hospital stay (6.09 days ORIF vs 9.08 days DFR, p<0.001) and more frequent blood transfusion (12.3% ORIF vs 44.0% DFR, p<0.001). Logistic regression analysis using propensity score matching (PSM) demonstrated no statistically significant difference in reoperation, hospital readmission, ambulatory status at 1-year, or 1-year mortality between the two cohorts. Lastly, applying Bayesian model averaging using PSM to identify risk factors for 1-year mortality demonstrated that increasing age, length of index hospital stay, and 90-day hospital readmission were significantly associated with 1-year mortality, regardless of type of surgical treatment. Rehospitalization, reoperation, ambulatory status and 1-year mortality are no different between ORIF and DFR in the treatment of geriatric periprosthetic distal femur fractures when PSM is applied to mitigate selection bias. Further study is warranted to elucidate functional outcomes, long-term sequelae, and costs of care related to these treatment options to better guide treatment planning. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

National Trends in Transplantation-Associated Intensive Care Unit Admission in South Korea From 2010 to 2019

We aimed to investigate the mortality and associated factors among patients admitted to the intensive care unit (ICU) after transplantation in South Korea. The South Korean National Health Insurance Service database was used as the data source. All adult patients (age ≥18 years) who were admitted to the ICU for organ transplantation-related causes from January 1, 2010 to December 31, 2019 (10 years) were included. Transplantation-associated ICU admissions were defined as admissions to the ward and ICU after transplantation or to the ICU before transplantation. A total of 23,994 ICU admissions after transplantation were included in the analysis (mean [SD] age: 52.7 [10.7] years; men: 67.0%; kidney transplantation: n=9638; liver transplantation: n=12,196; heart and/or lung transplantation: n=1829; pancreas or small bowel transplantation: n=331). Transplantation-associated ICU admissions gradually increased from 1666 in 2010 to 3014 in 2019. The 1-year mortality rates were 21.2%, 12.3%, 4.2%, and 3.0% after heart and/or lung, liver, pancreas or small bowel, and kidney transplantation, respectively. Invasive life support procedures during ICU stay, comorbidities, and older age were potential risk factors for 1-year mortality after transplantation. Transplantation-associated ICU admissions gradually increased from 2010 to 2019 in South Korea. The 1-year mortality rate after transplantation was the highest in the heart and/or lung transplantation group, followed by those of the liver, pancreas or small bowel, and kidney transplantation groups.

Acute Limb Ischemia after Cardiovascular Surgery: A Deadly Duo Combination with High Mortality.

Acute limb ischemia (ALI) is a predictor of high morbidity and mortality. Previous studies showed that ALI developed after cardiac surgery may increase mortality. This study aimed to elucidate the clinical course and identify risk factors contributing to mortality in patients with ALI after cardiovascular surgery. This is a single-center retrospective cohort study. We analyzed data from 52 patients with ALI after cardiovascular surgery between 2016 and 2020. We evaluated the risk factors for 1-year mortality using Cox proportional hazards regression analysis. Most of the patients with ALI were male and the median age was 56 years (23-72 years). Most of the patients with ALI had coronary artery diseases. The 1-year mortality rate was 55.8% ( n = 29 patients). Multivariable analysis revealed that cardiopulmonary bypass (CPB) time ≥ 100 minutes (hazard ratio [HR]: 3.067, 95% confidence interval [CI]: 1.158-8.120) and postoperative acute kidney injury (HR: 2.927, 95% CI: 1.358-6.305) were significantly increasing the risk of mortality in patients with ALI after an operation. ALI after cardiovascular surgery was associated with high 1-year mortality in our study and long CPB time and postoperative acute kidney injury contributed to the mortality.