Short-term In-hospital Outcomes Research Articles

757 Machine Learning-Driven Web Application for Enhanced Clinical Decision Support in Thoracolumbar Spinal Cord Injuries

INTRODUCTION: Thoracolumbar spinal cord injuries (tlSCI) can result in negative short-term in-hospital outcomes, underscoring the importance of precise prediction tools. METHODS: This retrospective cohort study included 147,826 patients from the American College of Surgeons Trauma Quality Program database. XGBoost, LightGBM, CatBoost, and Random Forest algorithms were utilized in combination with the Optuna optimization library for hyperparameter tuning. Models were evaluated graphically with receiver operating characteristic (ROC) curves, precision-recall curves, and numerically with precision, recall, F1 score, accuracy, area under ROC (AUROC), and area under PRC. The best-performing models were integrated into an open-access web application for individualized predictions. RESULTS: The best-performing models for each outcome were as follows: for predicting mortality, Random Forest achieved the highest AUROC (0.865, 95% CI 0.848-0.879); in predicting non-home discharges, LightGBM had the highest AUROC (0.801, 95% CI 0.794-0.804); and for predicting major complications, Random Forest performed best with an AUROC of 0.733 (95% CI 0.642-0.808). Algorithms' receiver operator curves for the outcomes: (A) mortality, (B) non-home discharges, and (C) major complications. CONCLUSIONS: This study successfully developed ML models to predict critical in-hospital outcomes for patients with tlSCI. By incorporating the top-performing algorithms into a user-friendly web application, these models have the potential to improve clinical decision-making and management strategies for tlSCI patients, ultimately enhancing patient care and outcomes.

Comparison of Short Term In-Hospital Outcomes in patients presenting with ST-Elevation Myocardial Infarction Versus Non-ST-Elevation Myocardial Infarction

Objective: To compare the short term in-hospital outcomes in patients presenting with acute ST-Elevation Myocardial Infarction (STEMI) and Non-ST-Elevation Myocardial Infarction (NSTEMI). Study Design: Comparative Cross-sectional study. Place and Duration of Study: Adult cardiology department of tertiary care center, Rawalpindi Pakistan, from Aug 2022 to Feb 2023. Methodology: A sample of 323 patients of acute STEMI and NSTEMI were enrolled. Patients fulfilling the inclusion criteria were enrolled through non-probability consecutive sampling. Patients were divided into two groups. The data of short term in hospital outcomes was recorded. Data was entered and analyzed using SPSS version-26:00. Chi-square and t-test were used to find association and mean difference of study variables between study groups. Results: Out of total 317 patients, males were 262(82.6%) and females were 55(17.4%)) with an average age of 63.34±8.96 years in the study. 139(43.8%) patients had Diabetes Mellitus, 146(46.1%) were hypertensive and 73(23.0%) were smokers. 198(62.5%) patients had STEMI and 119(37.5%) had NSTEMI. Mortality within hospital was found in 10(3.2%) patients. There were significant findings with age (p<0.001), gender (p<0.001), diabetes (p=0.01), pulmonary edema (p=0.01) and severe Left Ventricular Dysfunction (LVD) (p<0.001). Higher in-hospital mortality rate was noted in NSTEMI group, i.e. 5(4.2%) compared to STEMI 5(2.5%), but the findings were statistically insignificant (p=0.40). Conclusion: There was no meaningful distinction between the two groups' immediate outcomes. Although patients with NSTEMI had relatively higher complication rates and in-hospital mortality, and patients with STEMI had better short-term outcomes, suggesting that patients with NSTEMI may also require immediate medical attention.

Comparison of epidemiologic features between upper and lower limb injuries and risk factors for intensive care unit admission in a university hospital affiliated with the National Trauma Registry of Iran

PurposeUpper extremity injuries (UEIs) and lower extremity injuries (LEIs) constitute a considerable component of traumas. However, their epidemiologic differences and short-term in-hospital outcomes are not fully elucidated. This study aims to compare such discrepancies in a large-scale study. MethodsIn this retrospective study, all patients with UEIs and/or LEIs hospitalized from 24th July 2016 to 16th May 2020 in Sina Hospital, Tehran, Iran, and registered at the National Trauma Registry of Iran were enrolled in the study. Relevant demographic and clinical characteristics were extracted from the National Trauma Registry of Iran database. Patients were grouped into either UEI or LEI. For those with concomitant UEIs and LEIs, the more severe one based on the abbreviated injury scale was defined as the principal diagnosis. In addition, cases with the abbreviated injury scale > 3 for both UEI and LEI or concomitant injuries to body areas other than the limbs were excluded. Independent samples t-test, Mann-Whitney U test, Chi-square test, quintile regression models, and logistic regression models with “margins” command were used for statistical analyses, as indicated. ResultsIn this research, 3170 eligible cases were identified. For the LEI group, there was a much higher proportion of male patients (86.7% vs. 82.0%) and higher mean age (years, 42.9 vs. 35.3) compared to the UEI group (both p < 0.001). Patients with an injury severity score (ISS) of 9 – 15 were outnumbered in the LEI group (22.9% vs. 1.6%, p < 0.001), while the proportion of those with an ISS < 9 was higher in the UEI group (98.1% vs. 76.8%, p < 0.001). The multiple logistic regression model showed a statistically significant association between intensive care unit (ICU) admission and ISS (odds ratio (OR) = 4.01 for ISS 9 – 15 vs. ISS <9, 95% confidence interval (CI)|: 3.01 – 5.35; OR = 17.65 for ISS ≥16 vs. ISS < 9, 95% CI: 4.03 – 77.27), age (OR = 1.02, 95% CI: 1.01 – 1.03), cause of injury (OR = 0.27 for blunt trauma vs. road traffic crash, 95% CI: 0.08 – 0.90; OR = 0.49 for cut/stab injuries vs. road traffic crash, 95% CI: 0.28 – 0.84) and body region (OR = 1.65 for lower extremity, 95% CI: 1.19 – 2.29). Having adjusted for other covariates, the odds of ICU admission in patients with LEIs was 1.65 times the odds in patients with UEIs. ConclusionsPatients with LEIs were older and suffered from more severe injuries. In addition, the age- and ISS-adjusted ICU admission and length of hospital stay were significantly higher in LEI patients. The chance of ICU admission was associated with age, cause of injury, ISS, and body region. The findings of this study can aid in the meticulous selection of ICU-candidate patients. In addition, the role of factors other than ISS and age in ICU admission and prolongation of hospitalization should be addressed by prospective studies.

The impact of the cardiovascular risk factors on short-term in-hospital outcome of patients with COVID-19

The impact of the cardiovascular risk factors on short-term in-hospital outcome of patients with COVID-19

State and Government Administrative Databases: Medicare, National Inpatient Sample (NIS), and State Inpatient Databases (SID) Programs.

The availability of large state and federally run administrative health-care databases provides potentially comprehensive population-wide information that can dramatically impact both medical and health-policy decision-making. Specific opportunities and important limitations exist with all administrative databases based on what information is collected and how reliably specific data elements are reported. Access to patient identifiable-level information can be critical for certain long-term outcome studies but can be difficult (although not impossible) due to patient privacy protections, while more easily available de-identified information can provide important insights that may be more than sufficient for some short-term operative or in-hospital outcome questions. The first section of this paper by Sarah K. Meier and Benjamin D. Pollock discusses Medicare and the different data files available to health-care researchers. They describe what is and is not generally available from even the most granular Medicare Standard Analytic Files, and provide an analysis of the strengths and weaknesses of Medicare administrative data as well as the resulting best and inappropriate uses of these data. In the second section, the Nationwide Inpatient Sample and complementary State Inpatient Database programs are reviewed by Steven M. Kurtz and Edmund Lau, with insights into the origins of these programs, the data elements that are recorded relating to the operative procedure and hospital stay, and examples of the types of studies that optimally utilize these data sources. They also detail the limitations of these databases and identify studies that they are not well-suited for, especially those involving linkage or longitudinal studies over time. Both sections provide useful guidance on the best uses and pitfalls related to these important large representative national administrative data sources.

Perioperative Renin-Angiotensin System Inhibitors Improve Major Outcomes of Heart Failure Patients Undergoing Cardiac Surgery: A Propensity-Adjusted Cohort Study.

The aim of this study was to study the association of perioperative administration of renin angiotensin system inhibitors (RASi) and clinical outcomes of patients with heart failure (HF) undergoing cardiac surgery. It is controversial whether the perioperative RASi should be administered in HF patients undergoing cardiac surgery. A total of 2338 patients with HF and undergoing CABG and/or valve surgeries at multiple hospitals from 2001 to 2015 were identified from STS database. After adjustment using propensity score and instrumental variable, logistic regression was conducted to analyze the influence of preoperative continuation of RASi (PreRASi) on short-term in-hospital outcomes. Independent risk factors of 30-day mortality, major adverse cardiovascular events (MACE), and renal failure were analyzed by use of stepwise logistic regression. The effects of pre- and postoperative use of RASi (PostRASi) on long-term mortality were analyzed using survival analyses. Stepwise Cox regression was conducted to analyze the independent risk factors of 6-year mortality. The relationships of HF status and surgery type with perioperative RASi, as well as PreRASi-PostRASi, were also evaluated by subgroup analyses. PreRASi was associated with lower incidences of 30-day mortality [ P < 0.0001, odds ratio (OR): 0.556, 95% confidence interval (CI) 0.405-0.763], stroke ( P =0.035, OR: 0.585, 95% CI: 0.355-0.962), renal failure ( P =0.007, OR: 0.663, 95% CI: 0.493-0.894). Both PreRASi ( P =0.0137) and PostRASi ( P =0.007) reduced 6-year mortality compared with the No-RASi groups. Pre- and postoperative use of RASi was associated with better outcomes for the patients who have HF and undergo CABG and/or valve surgeries. Preoperative continuation and postoperative restoration are warranted in these patients.

Characteristics and In-Hospital Outcomes of Pediatric Traumatic Spinal Injuries in A Referral Trauma Center.

Objective:To evaluate the characteristics and in-hospital outcomes of traumatic spinal injuries among children admitted to a local trauma center in Iran. Methods:Patients aged 0-18 years who had been admitted to Shahid Kamyab trauma center for acute traumatic spinal injury (Mashhad, Iran) between 2011 and 2018 were evaluated retrospectively. Various demographic, clinical, radiological, and outcome variables were recorded and analyzed.Results:A total of 127,300 trauma patients were evaluated and amongst them, 61 children had spinal trauma. The mean age was 11.1 and there was no significant sex preponderance (54% males). Most of the injuries were occurred in summer (34.4%) and the most common trauma mechanism was motor vehicle accidents (55.7%) followed by falling (36.1%). Almost all patients (95.1%) had vertebral fractures, which were in the cervical, thoracic, and lumbosacral area in order to decrease incidence. 67.2% of patients were managed non-surgically. The mean hospital stay was 8.9 days and 82.0% of patients had been discharged with normal motor function. Conclusion:Pediatric spinal trauma is less studied entity in the field of traumatology due to the lower prevalence of these injuries in pediatric patients worldwide. But our study shows a higher prevalence of such injuries in the pediatric population. Although controversial, the leading cause of these injuries is motor vehicle accidents. Fortunately, short term in-hospital outcome seems to be good in such injuries.

Obesity Paradox in Short-Term Clinical Outcomes After Percutaneous Coronary Interventions

Background: The “obesity paradox”, a counterintuitive decrease in morbidity and mortality with increasing body mass index (BMI), has been shown in patients when acute cardiovascular decompensation occurs. However, whether this phenomenon exists in patients undergoing percutaneous coronary intervention (PCI) is not well known. The existence of obesity paradox and its impact on short-term clinical outcomes after PCI have not been thoroughly investigated, especially in Bangladesh. Methods: This cross-sectional observational study was conducted at National Institute of Cardiovascular Diseases, Dhaka, in 100 patients who underwent PCI. They were divided in two groups on the basis of BMI of Asian ethnicity: Group I (BMI &lt; 23 kg/m2) and Group II (BMI &lt;23.0 kg/m2). Short-term in-hospital outcomes after PCI were observed and recorded. Results: Acute left ventricular failure (LVF) was found to be statistically significant between groups (p &lt; 0.01) being higher in Group-I. The difference of mean duration of hospital stay (LOS) after PCI was higher in the same group which was statistically significant (p &lt; 0.01). Diabetes mellitus and dyslipidemia were found to be the independent predictors for developing adverse in hospital outcome (OR= 1.68 and 1.46; 95% CI = 1.25 – 2.24 and 1.16 – 1.83; p = 0.018 and 0.040, respectively). BMI was inversely associated with in-hospital outcomes after PCI (OR = 0.95; 95% CI = 0.91 – 0.98; p = 0.007). Conclusion: The results of the study uphold the phenomenon of the “obesity paradox” following PCI. The underweight and normal weight people are at greater risk to experience short-term in-hospital adverse clinical outcomes than overweight and obese people after PCI. Bangladesh Heart Journal 2021; 36(1): 1-8

Elevated Total Homocysteine Predicts In-Hospital Pneumonia and Poor Functional Outcomes in Acute Ischemic Stroke.

We investigated the association between elevated total homocysteine (tHcy) levels upon hospital admission and short-term in-hospital outcomes, including pneumonia in acute ischemic stroke (AIS) patients. A total of 2,084 AIS patients enrolled from December 2013 to May 2014 across 22 hospitals in Suzhou city were included in the present study. We divided patients into four groups according to their level of admission tHcy: quartile (Q1) (<9.70 umol/L), Q2 (9.70-12.3 umol/L), Q3 (12.3-16.9 umol/L), and Q4 (≥16.9 umol/L). Logistic regression models were used to estimate the effect of tHcy on the short-term outcomes, including in-hospital pneumonia, all-cause in-hospital mortality, and poor outcome upon discharge (modified Rankin Scale score ≥3) in AIS patients. The risk of in-hospital pneumonia was significantly higher in patients with the highest tHcy level (Q4) compared to those with the lowest tHcy level (Q1) (adjusted odds ratio [OR] 1.55; 95% confidence interval [CI], 1.03-2.33; P-trend =0.019). The highest tHcy level (Q4) was associated with a 3.35-fold and 1.50-fold increase in the risk of in-hospital mortality (OR 3.35; 95% CI, 1.11-10.13; P-trend =0.015) and poor outcome upon discharge (OR 1.50; 95% CI, 1.06-2.12; Ptrend =0.044) in comparison to Q1 after adjustment for potential covariates including pneumonia. Having a high admission tHcy level was independently associated with in-hospital pneumonia, in-hospital mortality, and poor outcome upon discharge in AIS patients.

IMPACT OF CHRONIC LUNG DISEASE ON IN-HOSPITAL OUTCOMES FOR PATIENTS ADMITTED WITH A PULMONARY EMBOLUS

SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: Several studies have suggested that chronic lung diseases (CLD) such as asthma and COPD are associated with a higher risk of developing a pulmonary embolism (PE). While much effort is focused on overcoming diagnostic challenges in patients with known lung conditions and concurrent PE, the data for short term in hospital outcomes is scarce. The aim of this study was to explore the impact of CLD on length of stay, total inpatient charges and in-hospital mortality in this population of patients presenting with PE. METHODS: This retrospective cohort study utilized data from the Nationwide Inpatient Sample (NIS) to identify adult patients (18+ years) from 2012-2015 who had been diagnosed with PE using the International classification of Diseases, Ninth Revision; Clinical modification (ICD9) codes. ICD9 codes were also used to identify patients with CLD as defined by the Elixhauser Comorbidity measures. Hospital length of stay (LOS), total inpatient charges, inpatient mortality, and average age at admission were assessed. ICD9 codes were also used to exclude patients with missing important clinical identifiers (age, gender, death, race). Encounters were separated into two groups: PE without CLD and PE with CLD, and compared using Chi-squared and independent t-tests. RESULTS: There were 212,330 encounters identified with a diagnosis of PE who met the inclusion criteria. Of these patients, 199,332 (93.9%) had a diagnosis of chronic pulmonary disease. The group with PE and concurrent chronic pulmonary disease had a significantly higher mortality (1.5% vs 5.9% p=0.000), as well as increased length of stay (4.11 vs 6.93 days p=0.000) and larger amount of total inpatient charges accumulated ($34,643 vs $64,001 p=0.000). The CLD group was older on average (68.35 vs 61.34 years old). CONCLUSIONS: Our data suggests that CLD may contribute to higher in-patient mortality, longer length of stay and higher total inpatient charges in patients diagnosed with CLD. We hope that these results highlight the importance of timely diagnosis and the need to focus on improving outcomes for this population of patients. CLINICAL IMPLICATIONS: The results from this study can lead to the continued research into factors that are contributing to the large discrepancy on in-hospital outcomes and assist clinicians in making important decisions in regards to patients presenting with pulmonary embolus who have concomitant CLD. DISCLOSURES: No relevant relationships by Russell Arellanes, source=Web Response No relevant relationships by Andrew Dang, source=Web Response No relevant relationships by Eugene Ismailov, source=Web Response No relevant relationships by Robert Stephens, source=Web Response

IMPACT OF ELECTROLYTE IMBALANCES ON SHORT-TERM IN-HOSPITAL OUTCOMES IN PATIENTS WITH PULMONARY EMBOLISM

SESSION TITLE: Monday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM PURPOSE: Pulmonary embolism (PE) is a common condition with significant comorbidity and mortality and remains a significant cause of high healthcare costs and hospital admissions. Previous studies have explored the risks of those patients with pulmonary embolism and particular comorbidities in relation to in-hospital outcomes. This study aims to further investigate short-term in-hospital outcomes of patients with the diagnosis of pulmonary embolism and the comorbid condition of electrolyte imbalances (EI). METHODS: This retrospective cohort study utilized data from the 2012-2015Q3 Nationwide Inpatient Sample. ICD-9 codes identified adult patients (age 18+) with the principal diagnosis of PE, and then further isolated patients diagnosed with electrolyte imbalances. Patients with principal diagnoses of respiratory failure or DVT were also included so long as they had a secondary diagnosis of PE. Data for patients who were missing important clinical identifiers (age, gender, race, mortality) were excluded. Patients diagnosed with acute cor pulmonale, iatrogenic PE, septic PE, and PE secondary to obstetrical complications were excluded to isolate diagnoses of PE arising de novo. Data analyses assessed hospital length of stay, inpatient charges, average age of admission, and mortality rate. RESULTS: Of the 857 encounters with patients diagnosed with PE, 248 patients had the comorbid diagnosis of EI. Hospital length of stay was significantly longer in those with the diagnosis of PE and EI (8.00 days with EI vs 5.98 days with no EI, p = 0.001) Total hospital charges were significantly increased ($89,373.65 with EI vs $54,186.61 with no EI, p < 0.0001) Mean mortality rate was significantly higher (10.5% with EI vs 4.9% with no EI, p = 0.005) CONCLUSIONS: This study aims to inform physicians to better manage patients with PE also diagnosed with electrolyte imbalances. These patients have a longer LOS, increased total hospital charges, and higher mortality rate than those without EI.. Future research should aim to investigate different levels of EI prior to determining treatment of those patients that present with PE. CLINICAL IMPLICATIONS: These findings suggest that optimizing management of electrolyte imbalances may be critical for improving hospital outcomes for patients with the diagnosis of PE. DISCLOSURES: No relevant relationships by Tatum Colburn, source=Web Response No relevant relationships by Anthony Olinger, source=Web Response No relevant relationships by Karen Tong, source=Web Response No relevant relationships by Angela Wang-Selfridge, source=Web Response

Comparison of PLEX vs. IVIG Treatments on Short-Term In-Hospital Outcomes in Patients with Myasthenia Gravis

Myasthenia gravis(MG) is an autoimmune neuromuscular disease caused by auto-antibodies binding to post-synaptic nicotinic acetylcholine receptors. Standard therapy for symptomatic MG include plasma exchange(PLEX), known as plasmapheresis, and intravenous immunoglobulin(IVIG). To date, neither PLEX or IVIG has established superior clinical benefit. This study aims to compare PLEX vs. IVIG in patients with MG.

Comparison of PLEX vs. IVIG on Short-Term In-Hospital Outcomes in Patients with Guillain Barre Syndrome

Guillain-Barré syndrome (GBS) is an acute post-infectious demyelinating polyneuropathy characterized by symmetric and ascending flaccid paralysis. Standard therapy for symptomatic GBS include plasma exchange(PLEX), known as plasmapheresis, and intravenous immunoglobulin(IVIG). To date, neither PLEX or IVIG has established superior clinical benefit. This study aims to compare PLEX vs. IVIG in patients with GBS.

Impact of Peripheral Vascular Disease on Short-Term In-Hospital Outcomes for Patients with Traumatic Brain Injury

Peripheral vascular disease (PVD) is associated with impaired neurocognitive recovery in acute traumatic brain injury (TBI) patients. There is sparse amount of literature reporting the impact of PVD on outcomes in this population. This study aims to further investigate the common comorbidity of PVD and its effects on the outcomes of short-term in-hospital patients after acute TBI.

Impact of COPD on Short-Term In-Hospital Outcomes for Patients with Acute Traumatic Brain Injury

Chronic obstructive pulmonary disease (COPD) is associated with impaired neurocognitive recovery in acute traumatic brain injury (TBI) patients. Patients with COPD who suffer from acute TBI are at increased risk of respiratory compromise, one of the most common causes of death within this population. There is sparse amount of literature reporting the impact of COPD on outcomes in this population. This study aims to investigate the effect of COPD on short-term in-hospital outcomes for patients after acute TBI.

Impact of HIV and AIDS on Short-Term In-Hospital Outcomes for Patients with Traumatic Brain Injury

Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) are associated with impaired neurocognitive recovery in acute traumatic brain injury (TBI) patients. There is sparse amount of literature reporting the impact of HIV/AIDS on outcomes in this population. This study aims to further investigate the common comorbidity of HIV/AIDS and its effects on the outcomes of short-term in-hospital patients after acute TBI.

Comparison of ST segment Changes in Lead aVR with in-Hospital Outcomes in Patients with First attack of Acute Inferior ST Segment Elevation Myocardial Infarction

Background: Inferior wall ST segment elevation myocardial infarction is considered to be at lower risk than anterior wall STEMI except in some cases. The aim of our study was to evaluate the relationships between on admission ST segment changes in lead aVR and short term in-hospital outcomes in acute isolated inferior myocardial infarction undergoing thrombolysis.&#x0D; Methods: Total 107 of first attack of inferior STEMI patients were included and all were thrombolysed by streptokinase. The sample population were divided into three groups based on the condition of ST segment in lead aVR on admission and in hospital outcomes were observed: Group –A: ST segment elevation ≥0.5 mm; Group –B: ST segment depression ≥0.5 mm; Group-C: Iso-electric ST segment.&#x0D; Results: 6.54% of study population had ST segment elevation in lead aVR, 53.27% had ST segment depression in lead aVR and 41.12% had isoelectric ST segment in lead aVR. During hospital stay mortality rates of patients of Group A, Group B and Group C were 33.3%, 5.3% and 4.5 % respectively; rates of cardiogenic shock were 33.3%, 8.8% and 2.3% respectively; heart failure rates were 50.0%, 15.8% and 4.5% respectively; rates of recurrent angina after thrombolysis were 66.7%, 33.3% and 6.8% respectively in three groups and the mean LVEF were 40.17, 48.61 and 52.50 respectively.&#x0D; Conclusion: The on admission-isoelectric ST segment in lead aVR in acute inferior myocardial infarction predicted better in-hospital outcomes in comparison to ST segment elevation and ST segment depression in aVR. On the other hand, ST segment elevation in lead aVR predicted worse in-hospital outcomes than ST segment depression in acute inferior myocardial infarction in spite of reperfusion by thrombolytic.&#x0D; Cardiovasc. j. 2019; 11(2): 123-128

IMPACT OF TYPE II DIABETES MELLITUS ON SHORT-TERM IN-HOSPITAL OUTCOMES OF SEPSIS ADMISSIONS

SESSION TITLE: Critical Care 1 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM PURPOSE: Type II diabetes mellitus is a proinflammatory state which increases susceptibility for severe infections. Sepsis activates a proinflammatory pathway within the body causing an increased cortisol response. When left unchecked, a cytokine storm subsequently causes multiorgan failure and death. The NICE-SUGAR trial demonstrated a liberal blood sugar control to reduce mortality in critically ill patients, however subgroup analysis showed the liberal blood sugar control group to have increased incidence of infections. The prevalence of diabetes and pre-hospitalization glycemic control are considered here to be individual factors to help predict sepsis outcomes. This study seeks to examine the effects of diabetes on sepsis admissions by examining short-term in-hospital outcomes and rate of organ failure. METHODS: This retrospective cohort study utilized information from the 2012-2014 Nationwide Inpatient Sample (NIS) to identify adult patients (18+ years) with a primary diagnosis of septicemia, septicemic, bacteremia, disseminated fungal infection, disseminated candida infection, or disseminated fungal endocarditis. Selected patients were analyzed for type II diabetes mellitus. Exclusions included patients with diabetes with ketoacidosis or hyperosmolarity, diabetic coma, type I diabetes, or patients missing important clinical identifiers. RESULTS: 648,602 sepsis admissions were identified including 205,749 with type II diabetes and 442,853 without type II diabetes. Increased mortality was observed in the non-diabetic patients (13.4% vs 11.1%, p<.001, OR .81, CI .80-.82), while patients with type II diabetes had increased LOS (7.7 vs 7.6 days, p<.001), age at admission (68.7 vs 65.7 years, p<.001), and number of chronic conditions (8.0 vs 6.0, p<.001). There was no difference in total charges. Examination of organ failure rates demonstrated increased respiratory (24.6% vs 22.1%, p<.001, OR 1.15, CI 1.13-1.16), cardiovascular (7.7% vs 7.0%, p<.001, OR 1.11, CI 10.09-1.14), hepatic (3.9% vs 3.0%, p<.001, OR 1.31, CI 1.27-1.35), and hematologic (11.0% vs 9.3%, p<.001, OR 1.21, CI 1.18-1.23) organ failures in non-diabetic admissions. Septic admissions with type II diabetes were found to have higher rates of renal failure (49.4% vs 42.2%, p<.001, OR .75, CI .74-.76). There were no differences in rate of metabolic (16.8% vs 16.9%) or neurologic (2.7% vs 2.8%) organ failures between non-diabetic and diabetic admissions, respectively. CONCLUSIONS: Non-diabetic septic patients have higher mortality rates than diabetic septic patients despite increased age, LOS and number of chronic conditions in diabetics. As expected, septic patients with diabetes demonstrated higher rates of renal failure. CLINICAL IMPLICATIONS: Clinicians must be proactive with sepsis regardless of diabetic status due to high mortality. Understanding organ failure rates can aid in early monitoring and treatment during sepsis admissions. DISCLOSURES: No relevant relationships by Jacob Baer, source=Web Response No relevant relationships by Sai Guda, source=Web Response No relevant relationships by Catherine Mayer, source=Web Response

Prognosis of diffuse axonal injury with traumatic brain injury

Determine the prognostic impact of magnetic resonance imaging (MRI)-defined diffuse axonal injury (DAI) after traumatic brain injury (TBI) on functional outcomes, quality of life, and 3-year mortality. This retrospective single center cohort included adult trauma patients (age > 17 years) admitted from 2006 to 2012 with TBI. Inclusion criteria were positive head computed tomography with brain MRI within 2 weeks of admission. Exclusion criteria included penetrating TBI or prior neurologic condition. Separate ordinal logistic models assessed DAI's prognostic value for the following scores: (1) hospital-discharge Functional Independence Measure, (2) long-term Glasgow Outcome Scale-Extended, and (3) long-term Quality of Life after Brain Injury-Overall Scale. Cox proportional hazards modeling assessed DAI's prognostic value for 3-year survival. Covariates included age, sex, race, insurance status, Injury Severity Score, admission Glasgow Coma Scale Score, Marshall Head computed tomography Class, clinical DAI on MRI (Y/N), research-level anatomic DAI Grades I-III (I, cortical; II, corpus callosum; III, brainstem), ventilator days, time to follow commands, and time to long-term follow-up (for logistic models). Eligibility criteria was met by 311 patients, who had a median age of 40 years (interquartile range [IQR], 23-57 years), Injury Severity Score of 29 (IQR, 22-38), intensive care unit stay of 6 days (IQR, 2-11 days), and follow-up of 5 years (IQR, 3-6 years). Clinical DAI was present on 47% of MRIs. Among 300 readable MRIs, 56% of MRIs had anatomic DAI (25% Grade I, 18% Grade II, 13% Grade III). On regression, only clinical (not anatomic) DAI was predictive of a lower Functional Independence Measure score (odds ratio, 2.5; 95% confidence interval, 1.28-4.76], p = 0.007). Neither clinical nor anatomic DAI were related to survival, Glasgow Outcome Scale-Extended, or Quality of Life after Brain Injury-Overall Scale scores. In this longitudinal cohort, clinical evidence of DAI on MRI may only be useful for predicting short-term in-hospital functional outcome. Given no association of DAI and long-term TBI outcomes, providers should be cautious in attributing DAI to future neurologic function, quality of life, and/or survival. Epidemiological, level III; Therapeutic, level IV.

Gender disparities with the use of percutaneous left ventricular assist device in patients undergoing percutaneous coronary intervention complicated by cardiogenic shock: From pVAD Working Group

BackgroundHemodynamic support with Impella (Abiomed Inc., Danvers, MA) devices is becoming a more prevalent treatment option for patients with cardiogenic shock (CS) undergoing percutaneous coronary intervention (PCI). There exists only limited published data regarding outcome differences between male and female patients. Therefore, the objective of this paper is to analyze these gender differences between short-term survival and in-hospital outcomes in those undergoing PCI with CS. MethodsBetween January 2011 and July 2016, patients undergoing PCI with simultaneous use of Impella were identified. Only patients presenting with CS were included in the analysis. All-cause in-hospital mortality was the primary outcome. Using SAS 9.4 for propensity score matching, additional secondary outcomes were also compared. ResultsThe primary outcome was comparable between males and females (39.5% vs. 26.3%, p=0.33) in CS patients. Secondary outcomes were also comparable and included: myocardial infarction, stroke, CS, heart failure, dialysis requirement, bleeding within 72h, blood transfusion, dysrhythmia, composite of all complications, major adverse cardiac events. Survival at 30days was equal in both groups. A reduced mortality in males was noted for pre-PCI initiation of Impella. Additionally, both genders who received pre-PCI Impella support, experienced a significant reduction in inotrope use. ConclusionsDespite the small number of cohorts, this study did not reveal any significant differences among gender with the use of percutaneous left ventricular assist devices for PCI in patients with acute myocardial infarction complicated by CS. However, initiation of Impella prior to PCI may be associated with improved mortality and morbidity in both genders.