Risk Factors For Early Mortality Research Articles

Outcomes of total anomalous pulmonary venous drainage and predictors of mortality—Tertiary center experience

BackgroundTotal anomalous pulmonary venous drainage (TAPVD) is a rare congenital anomaly associated with a high mortality rate, especially when associated with complex congenital heart disease (CHD). ObjectivesTo present the experience in managing TAPVD patients, along with mid to long-term outcomes. MethodsThis is a retrospective study, conducted between 2011 to 2020, aiming to document outcomes and identify predictors for mortality. ResultsA total of forty-nine patients were included. The mean follow-up time, median gestational age, weight and age at operation were 4.6 years (± 2.3 years), 38 weeks (32-42 weeks), 3.2 kilograms (1.8-50 kg) and 17 days (0-8395 days), respectively. Thirty-four patients had isolated disease while 15 patients had complex TAPVD (10 univentricular). Pre- and postoperative pulmonary venous obstruction (PVO) were documented at 24.5% and 21%, respectively. The mortality rate was at 16% and highly associated with the complex group (p = 0.000). Multivariate analysis revealed univentricular physiology (SV), cardiopulmonary bypass time, rectal temperature and open chest as the only independent risk factors for early mortality. ConclusionOutcomes were excellent in patients with the isolated type, but mortality remained high within the complex group, except for a subset of patients with unobstructed, cardiac-type TAPVD associated with Heterotaxy and SV physiology. Death continues to be associated with previously identified risk factors along with operative rectal temperatures and a postoperative open chest. PVO was not identified as a risk factor for death, except in univariate analysis, with good outcomes following secondary repair to relieve the obstruction. Overall survival beyond hospital discharge offers excellent outcomse.

Dissatisfaction with Married Life in Men Is Related to Increased Stroke and All-Cause Mortality

The objectives of this study were to assess the association between marital satisfaction and specific and all-cause mortality, and to examine whether this association is independent of other known risk factors for early mortality. In this prospective cohort, male Israeli civil servants and municipal employees (n = 8945) underwent an extensive appraisal of health and behavioral patterns and were followed for more than three decades. Cox proportional hazards analysis was used to estimate the relative risks for stroke and all-cause mortality over time across marital satisfaction categories. During the 32 years of follow-up, 5736 (64.1%) died. Dissatisfaction with married life was related to increased long-term risk of stroke (HR = 1.94; 95%CI, 1.41–2.90) and all-cause mortality (HR = 1.21; 95%CI, 1.04–1.41). The latter association was of a similar order of magnitude to other known risk factors for early mortality, such as people with a history of smoking (HR = 1.37; 95%CI, 1.30–1.48) compared to people who have never smoked and for physically inactive participants (HR = 1.21; 95%CI, 1.14–1.37) compared to physically active participants. The results of our study suggest that marital dissatisfaction may predict an elevated risk of all-cause mortality. Assessing marital satisfaction and measuring the health benefits of marital education programs for couples should be implemented as part of health promotion strategies for the general population.

Risk analysis for early mortality in emergency acute type A aortic dissection surgery: experience of Tokyo Acute Aortic Super-network.

We investigated the various pre- and postoperative complications related to early (30-day) mortality after open surgery for acute type A aortic dissection. Data from the Tokyo Acute Aortic Super-network database spanning January 2015 to December 2017 were retrospectively reviewed. Pre- and postoperative factors related to early postoperative mortality were assessed in 1504 of 2058 (73.0%) consecutive patients [age: 66.6 (SD: 13.5) years, male: 52.9%] who underwent acute type A aortic dissection repair. The early mortality rate following surgical repair was 8.9%. According to multivariable analysis, male sex [odds ratio (OR) 1.670, 95% confidence interval (CI) 1.063-2.624, P = 0.026], use of percutaneous circulatory assist devices (n = 116, 7.7%) including extracorporeal membrane oxygenators or intra-aortic balloon pumps (OR 4.857, 95% CI 2.867-8.228, P < 0.001), shock (n = 162, 10.8%) (OR 3.06, 95% CI 1.741-5.387, P < 0.001), cardiopulmonary arrest (n = 41, 2.7%) (OR 7.534, 95% CI 3.407-16.661, P < 0.001), coronary ischaemia (n = 36, 2.3%) (OR 2.583, 95% CI 1.042-6.404, P = 0.041) and cerebral ischaemia (n = 59, 3.9%) (OR 2.904, 95% CI 1.347-6.261, P = 0.007) were independent preoperative risk factors for early mortality, while cardiac tamponade (n = 34, 2.3%) (OR 10.282, 95% CI 4.640-22.785, P < 0.001), cerebral ischaemia (n = 80, 5.3%) (OR 2.409, 95% CI 1.179-4.923, P = 0.016) and mesenteric ischaemia (n = 15, 1.0%) (OR 44.763, 95% CI 13.027-153.808, P < 0.001) were independent postoperative risk factors. Not only critical preoperative conditions but also postoperative cardiac tamponade and vital organ ischaemia are risk factors for early mortality after acute type A aortic dissection repair.

The risk factors for early mortality and end-stage renal disease in anti-neutrophil cytoplasmic antibody-associated glomerulonephritis: experiences from a single center.

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a common disease with high mortality. Kidney involvement in AAV commonly performances as ANCA-associated glomerulonephritis (AAGN). We aimed to identify the risk factors for mortality and end-stage renal disease(ESRD) within 6months since diagnosis in AAGN patients. A total of 350 AAGN patients were enrolled in our center between 2004 and 2017 retrospectively. We analyzed the demographic, clinical and follow-up data. Factors for mortality and ESRD were investigated with univariate and multivariate Cox regression models. The median follow-up time was 60.8 (IQR 31.2, 84.5) months and 40 (11.4%) patients died within the first 6months. In the multivariate analysis, age ≥ 65years (HR = 2.245, 95%CI 1.085-4.645, P = 0.029), high leukocyte counts (HR = 1.089, 95%CI 1.015-1.168, P = 0.018), high Birmingham Vasculitis Activity Score (BVAS) (HR = 1.089, 95%CI 1.017-1.165, P = 0.014), infection (HR = 2.023, 95%CI 1.013-4.042, P = 0.046) and low serum albumin (HR = 0.916, 95%CI 0.845-0.992, P = 0.030) were independent risk factors for all-cause mortality in the first 6months. A total of 95 patients reached ESRD within the first 6months. The renal survival rate was 72.9% at 6months. Multivariate analysis showed that high BVAS (HR = 1.198, 95%CI 1.043-1.376, P = 0.011), high daily urine protein (HR = 1.316, 95%CI 1.046-1.656, P = 0.019) and low eGFR (HR = 0.877, 95%CI 0.804-0.957, P = 0.003) were independent risk factors for ESRD. The mortality and ESRD rates were high in the first 6months for AAGN patients. High disease activity evaluated by BVAS impacted both on patients' survival and renal survival, while over 65years of age and infection were risk factors for mortality.

High Grade Primary Graft Dysfunction after Lung Transplantation is Associated with Acute Rejection but Not Chronic Allograft Dysfunction

Purpose Evidence suggests that high grade primary graft dysfunction after lung transplantation (LTx) is a major threat for early and late outcomes. Herein, we aim to examine the risk factors and clinical impact of PGD in a contemporary cohort at a single center. Methods From 1/2008 to 7/2018, 1147 LTx procedures were performed at our institution. Clinical data was prospectively collected and PGD defined according to ISHLT criteria. Median follow up was 3.3 years (interquartile range 1.2 - 7.4). Multi-variable analysis utilizing recipient, donor, and LTx procedure variables was performed to assess risk factors for PGD, acute rejection, chronic lung allograft dysfunction (CLAD), early mortality, and late survival. Results Out of 1147 LTx procedures, 61% were bilateral. The incidence of PGD (grade II & III) was 13% & 15% at 24 hr , 12% & 14% at 48 hr , and 12% & 14% at 72 hr, respectively. Multi-variable analysis identified cardiopulmonary bypass usage/duration, single LTx, recipient pulmonary arterial hypertension, longer ischemic time, earlier year of LTx, older donor, higher Lung Allocation Score, and higher ratio of recipient/donor weight as risk factors for high grade PGD (grade II or III at 48-72 hr). Notably, recipient body mass index, donor smoking history, and diabetes were not significant risk factors for high grade PGD. Further analysis demonstrated that PGD II or III at 48-72 hr were independent significant risk factors for early mortality and higher acute rejection grades, while not significantly associated with CLAD or late survival. PGD grade II or III at 24 hr were not significant risk factors for early mortality, acute rejection, CLAD, or late survival. Conclusion This single-center data analysis of > 1000 contemporary lung transplants identified risk factors for high grade PGD. While high grade PGD at 48-72 hr was associated with higher risk of early mortality and acute rejection, in contrast to previous studies, it was not associated with a higher risk of CLAD or late survival, perhaps due to evolving management strategies.

Risk Factors of Early Mortality and Morbidity in Esophageal Atresia with Distal Tracheoesophageal Fistula: A Population-Based Cohort Study

To identify the risk factors for early mortality and morbidity in a population with distal esophageal atresia (EA)-tracheoesophageal fistula. Cohort study from a national register. Main outcomes and measures included early mortality, hospital length of stay (LoS), need for nutritional support at 1year of age as a proxy measure of morbidity, and complications during the first year of life. In total, 1008 patients with a lower esophageal fistula were included from January 1, 2008, to December 31, 2014. The survival rate at 3months was 94.9%. The cumulative hospital LoS was 31.0 (17.0-64.0) days. Multivariate analysis showed that intrahospital mortality at 3months was associated with low birth weight (OR 0.52, 95% CI [0.38-0.72], P<.001), associated cardiac abnormalities (OR 6.09 [1.96-18.89], P = .002), and prenatal diagnosis (OR 2.96 [1.08-8.08], P = .034). LoS was associated with low birth weight (-0.225±0.035, P<.001), associated malformations (0.082±0.118, P<.001), surgical difficulties (0.270±0.107, P<.001), and complications (0.535±0.099, P<.001) during the first year of life. Predictive factors for dependency on nutrition support at 1year of age were complications before 1year (OR 3.28 [1.23-8.76], P<.02) and initial hospital LoS (OR 1.96 [1.15-3.33], P<.01). EA has a low rate of early mortality, but morbidity is high during the first year of life. Identifying factors associated with morbidity may help to improve neonatal care of this population.

Risk Factors for Early Mortality with Inferior Vena Cava Filters

Inferior vena cava filters (IVCF) placement is a low risk procedure. Yet, a significant number of patients expire within 30 days of insertion because of underlying disease. The benefit of IVCF placement in this group of patients is debaTable. This study aims to assess the incidence and risk factors for early mortality after IVCF placement in a tertiary care center.

Outcomes from adult veno-arterial extracorporeal membrane oxygenation in a cardiovascular disease center from 2009 to 2019.

Extracorporeal membrane oxygenation (ECMO) is an imperative short-term cardiopulmonary support device now. We aimed to provide a single-center experience of veno-arterial (V-A) ECMO management and identify the risk factors of in-hospital mortality. We conducted a retrospective review of adult patients who received V-A ECMO between 2009 and 2019 in a cardiovascular disease center. The risk factor analysis of in-hospital mortality was conducted. The study reviewed 236 patients, with an overall survival rate of 68.2%. The survivors' blood lactate concentration is significantly lower than non-survivors [7.4 (7.8) vs 11.1 (9.7), p = 0.002]. Patients who received heart transplantation were with higher in-hospital survival rate. Survivors developed less hepatic dysfunction, acute kidney injury and myocardial damage [23 (14.3%) vs 19 (25.3%), p = 0.039; 81 (50.3%) vs 51 (68%), p = 0.011; 24 (14.9%) vs 22 (29.3%), p = 0.009, respectively], with higher rate of continuous renal replacement therapy (CRRT) [56 (34.8%) vs 53 (70.7%), p < 0.001]. Fewer survivors' 24 hours and total chest drainage was over 1000 mL, and the rate of re-exploration as well as red blood cell and platelet transfusion were lower in survivors. In multivariate analysis, female, pre-ECMO blood lactate concentration, hyperlipidemia, CRRT, and 24 hours chest drainage ⩾ 1000 mL were risk factors of early mortality. By providing a general description of V-A ECMO practice at a single-center in China. Post-heart transplant graft failure was associated with numerically, the greatest survival in our practice. Furthermore, female sex, pre-ECMO blood lactate concentration, hyperlipidemia, CRRT, and high blood loss in chest drains are predictors of mortality in patients who undergo V-A ECMO.

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.