Short-term Outcomes In Patients Research Articles

Clinical characteristics and short-term outcomes of patients with critical acute pulmonary embolism requiring extracorporeal membrane oxygenation: from the COMMAND VTE Registry-2

BackgroundExtracorporeal membrane oxygenation (ECMO) might be required as a treatment option in patients with critical pulmonary embolism (PE). However, the clinical features and outcomes of the use of ECMO for critical acute PE are still limited. The present study aimed to clarify the clinical characteristics, management strategies and outcomes of patients with acute PE requiring ECMO in the current era using data from a large-scale observational database.MethodsWe analyzed the data of the COMMAND VTE Registry-2: a physician-initiated, multicenter, retrospective cohort study enrolling consecutive patients with acute symptomatic venous thromboembolism (VTE). Among 2035 patients with acute symptomatic PE, there were 76 patients (3.7%) requiring ECMO.ResultsOverall, the mean age was 58.4 years, and 34 patients (44.7%) were men. Cardiac arrest or circulatory collapse at diagnosis was reported in 67 patients (88.2%). The 30-day incidence of all-cause death was 30.3%, which were all PE-related deaths. The 30-day incidence of major bleeding was 54.0%, and the vast majority of bleedings were procedure site-related bleeding events and surgery-related bleeding (22.4%). The 30-day incidence of all-cause death was 6.3% in 16 patients with surgical intervention, 43.8% in 16 patients with catheter intervention, 25.0% in 16 patients with thrombolytic therapy, and 39.3% in 28 patients with anticoagulation only.ConclusionsThe current large real-world VTE registry in Japan revealed clinical features and outcomes of critical acute PE requiring ECMO in the current era, which suggested several unmet needs for future clinical trials.

Early intravenous branched-chain amino acid-enriched nutrition supplementation in older patients undergoing gastric surgery: a randomized clinical trial

BackgroundThe initiation time and formula for supplemental parenteral nutrition after surgery require optimization, especially in older patients undergoing major gastrointestinal surgery. This study aimed to assess the effect of early supplementation with a branched-chain amino acid (BCAA)-enriched formula (BAF) on short-term postoperative outcomes in older patients undergoing gastric surgery.MethodsThis single-center, prospective, double-blinded, randomized clinical trial was conducted from March 10, 2020, to September 15, 2022. Patients aged 65–80 years with gastric cancer scheduled for curative resection were assessed for eligibility and randomly allocated to a high-proportion BCAA (HBCAA) (early supplementation with the BAF) or control (routine nutrition) group. The primary outcome was the standardized length of hospital stay (LOS).ResultsA total of 150 patients were randomized. Thirteen patients were excluded due to the resection of other organs, presence of metastasis, or withdrawal of consent. Finally, we included 70 and 67 patients in the HBCAA and control groups, respectively (mean age: 70.5 ± 4.2 years; 96 men [70.1%]). The standardized LOS was significantly shorter in the treatment group than in the control group (median [interquartile range]: 8.0 [7.8, 8.0] vs. 8.5 [8.0, 9.0] days; mean difference, 0.38; 95% confidence interval [CI], 0.02–0.74 days; P < .001). Patients in the HBCAA group showed better gastrointestinal function with faster defecation (4.0 [3.6, 5.0] vs. 5.0 [4.0, 5.5] days; mean difference, 0.6 days; 95% CI, 0.26–0.94 days; P < .001) and semi-liquid diet initiation (8.0 [7.5, 8.0] vs. 8.0 [8.0, 8.8] days; mean difference, 0.36 days; 95% CI, 0.03–0.7 days; P < .001) and had lesser weight loss at postoperative day 5 than those in the control group did (3.5 [2.7, 6.5] vs. 4.9 [3.3, 7.6]%; mean difference, 1.23%; 95% CI, 0.27–2.19%; P = .011).ConclusionsIn this randomized clinical trial, compared with routine nutrition, early supplementation with a BAF was associated with a shorter standardized LOS in older patients undergoing gastric surgery, suggesting that it may be a favorable strategy for patients with a poor tolerance to external nutrition who are undergoing major surgery.Trial registrationClinicalTrials.gov; Identifier: ChiCTR2000029635.

Safety and efficacy of surgical revascularization with percutaneous ventricular assist device for acute myocardial infarction complicated by cardiogenic shock: Japanese national registry study.

This study aims to assess the safety of coronary artery bypass grafting (CABG) with percutaneous ventricular assist device (PVAD) in patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS). A retrospective analysis was conducted on 1198 patients with AMI-CS from the J-PVAD registry, who underwent PVAD support using Impella® (Abiomed Inc., Danvers, MA) and subsequent revascularization between February 2020 and December 2021. Patients were divided into two groups based on the method of coronary revascularization: percutaneous coronary intervention (PCI, n = 1084) and CABG (n = 114). The study assessed short-term all-cause and cardiac-related mortality. The CABG group exhibited significantly lower short-term all-cause mortality compared with the PCI group (30-day: 26.2% vs. 39.9%, 90-day: 45.5% vs. 58.4%, log-rank p = 0.004). Short-term cardiac-related mortality was similar toward low in the CABG group compared with the PCI group (30-day: 18.7% vs. 25.6%, 90-day: 29.4% vs. 35.5%, log-rank p = 0.084). Multivariable analysis using the Cox proportional hazard model did not identify revascularization strategy as a risk factor for both all-cause mortality (Hazard ratio (HR): 0.743, 95% confidence intervals (CI): 0.457-1.208, p = 0.231) and cardiac-related mortality (HR: 0.762, 95% CI: 0.390-1.490, p = 0.427). These results were not attenuated even in subgroup analyses separately comparing CABG alone and hybrid therapy with PCI after propensity score matching. Thus, CABG can be a treatment option with feasible short-term outcomes in patients with AMI-CS under PVAD support.

Gender-Dependent Association Between Thyroid Hormones and Severity of Coronary Artery Disease by SYNTAX Score

Thyroid function has been shown to be associated with cardiovascular diseases. Moreover, sex can influence on the association between thyroid function and other diseases. We aimed to evaluate the relationship between thyroid hormones and the severity of coronary artery disease (CAD) and outcomes. In a prospective study, patients with chest pain undergoing diagnostic coronary angiography were evaluated. Patients were categorized based on the number of involved coronary arteries. Moreover, the severity of CAD was quantitatively calculated using the Syntax score (SS). All patients were also followed up for 3-month duration. The level of TSH in 150 patients was significantly higher in females than males (3.1 [1.7, 5] versus 1.8 [1, 3.3] mU/L; P=0.002). There was significant correlation between THS and the SS among females (ρ=0.477, P&lt;0.001), but not males. Among both sexes, thyroid hormones were comparable between those with or without events during follow-up. The main predictors of high SS values included age (odds ratio [OR] 1.060, 95% confidence interval [CI] 1.018-1.104; P=0.005) and female (OR 2.941, 95% CI 1.198-7.218). The main predictors of multivessel disease were age (OR 1.077, 95% CI 1.026-1.132), female (OR 5.853, 95% CI 1.880-18.222), thyroxin (OR 0.733, 95% CI 0.547-0.981), and thyrotropin (OR 1.333, 95% CI 1.079-1.647). Thyroid hormones are associated with the presence and the severity of CAD, but it might be sex-related. However, thyroid hormone levels could not predict short-term outcomes of patients.

Predictive Value of Immune Activity Changes in Breast Cancer Patients Treated With Dose-dense Neoadjuvant Chemotherapy: A Retrospective Study.

Dose-dense chemotherapy is recommended for patients with breast cancer who have a high recurrence risk. However, whether dose-dense neoadjuvant chemotherapy (ddNAC) improves patient prognoses compared to the normal-dose regimen remains controversial. In this study, we evaluated the predictive value of immune activities on short-term outcomes for patients treated with ddNAC. We classified 82 patients with human epidermal growth factor receptor 2-negative breast cancer treated with NAC into a normal dose group (62 patients) and ddNAC group (20 patients) and examined the differences in clinicopathological features. The ddNAC group was further divided according to patient responses to NAC and the predictive factors for pathological complete response (pCR) were evaluated. There were no differences in the clinicopathological features before NAC between the normal dose and ddNAC groups. Although the pCR rates tended to be higher in the ddNAC group compared than those in the normal dose group (35.0% vs. 25.8%), there was not significant difference (p=0.264). Among all patients treated with ddNAC, the absolute lymphocyte count decreased and the neutrophil-to-lymphocyte ratio increased during dose-dense doxorubicin plus cyclophosphamide treatment. There was no significant correlation between the pCR and any of the clinicopathological parameters tested including systemic peripheral markers and tumor-infiltrating lymphocyte levels. ddNAC affected the levels of systemic peripheral immune markers. However, monitoring these markers may not be useful for predicting responses to ddNAC.

The Benefits of Early Rehabilitation for Patients With Acute Heart Failure Requiring IV Inotropic Drugs.

The benefits of early rehabilitation for patients with acute heart failure (HF) requiring IV inotropic drugs have yet to be determined. We investigated the association between early rehabilitation and short-term clinical outcomes in patients with acute HF requiring IV inotropic drugs. Retrospective cohort study. This study used data including more than 90% of patients at a tertiary emergency hospital in Japan. This study included patients with acute HF who required IV inotropic drugs within 2 days of admission. We compared patients who commenced rehabilitation within 2 days of admission (the early rehabilitation group) and those who did not (the control group). Propensity score matching was used to compare in-hospital mortality, 30-day all-cause and HF readmissions, length of stay, and Barthel Index (BI) at discharge between patients who received early rehabilitation and those who did not. Totally, 38,302 patients were eligible for inclusion; of these, 5,127 received early rehabilitation and 5,126 pairs were generated by propensity score matching. After propensity score matching, the patients who received early rehabilitation had a lower in-hospital mortality rate than those who did not (9.9% vs. 13.2%; p < 0.001). The relative risk (95% CI) of early rehabilitation for in-hospital mortality was 0.75 (0.67-0.83). Patients undergoing early rehabilitation exhibited a shorter mean length of stay (25.5 vs. 27.1; p < 0.001), lower 30-day all-cause (14.1% vs. 16.4%; p = 0.001) and HF (8.6% vs. 10.4%; p = 0.002) readmissions, and higher BI scores at discharge (68 vs. 67; p = 0.096). Consistent findings were observed across subgroups, including in patients 80 years old or older, those with a body mass index less than 18.5 kg/m2, and those with BI scores less than 60. The early prescription of rehabilitation was associated with favorable short-term outcomes even for patients with acute HF requiring IV inotropic drugs.

Vascular occlusion for optimising the functional improvement in patients with knee osteoarthritis: a randomised controlled trial.

Knee osteoarthritis (KOA) is a leading cause of global disability with conventional exercise yielding only modest improvements. Here we aimed to investigate the benefits of integrating blood flow restriction (BFR) into traditional exercise programmes to enhance treatment outcomes. The Vascular Occlusion for optimizing the Functional Improvement in patients with Knee Osteoarthritis randomised controlled trial enrolled 120 patients with KOA at Ghent University Hospital, randomly assigning them to either a traditional exercise programme or a BFR-enhanced programme over 24 sessions in 12 weeks. Assessments were conducted at baseline, 6 weeks, 12 weeks and 3 months postintervention using linear mixed models with Dunn-Sidak corrections for multiple comparisons. Primary outcome was the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire at 3 months follow-up with knee strength, Pain Catastrophizing Scale questionnaire and functional tests as secondary outcomes. Analysis followed an intention-to-treat approach (NCT04996680). The BFR group showed greater improvements in KOOS pain subscale (effect size (ES)=0.58; p=0.0009), quadriceps strength (ES=0.81; p<0.0001) and functional tests compared with the control group at 12 weeks. At 3 months follow-up, the BFR group continued to exhibit superior improvements in KOOS pain (ES=0.55; p=0.0008), symptoms (ES=0.59; p=0.0004) and quality of life (QoL) (ES=0.66; p=0.0001) with sustained benefits in secondary outcomes. Drop-out rates were similar in both groups. Incorporating BFR into traditional exercise programmes significantly enhances short-term and long-term outcomes for patients with KOA demonstrating persistent improvements in pain, symptoms, QoL and functional measures compared with conventional exercise alone. These findings suggest that BFR can provide the metabolic stimulus needed to achieve muscle strength and functional gains with lower mechanical loads. Reduced pain and increased strength support a more active lifestyle, potentially maintaining muscle mass, functionality and QoL even beyond the supervised intervention period. NCT04996680.

Gender disparities in short-term outcomes of STEMI patients: the influence of universal health coverage

Abstract Background Even after the event, individuals recovering from ST-elevation myocardial infarction (STEMI) face lingering risks, including potential subsequent events and mortality. The introduction of Universal Health Coverage (UHC) seeks to enhance healthcare outcomes for all segments of the population. Purpose This study evaluates the effect of UHC on 30-day mortality in post-STEMI patients, focusing on medication access and treatment disparities. Using a gender-stratified approach, we analyze changes before and after UHC implementation to provide insights into the difference in therapy between genders and how gender influences healthcare outcomes for post-STEMI patients. Methods Analyzing two cohorts, Cohort 1 (211 STEMI patients, 2013-2014 pre-UHC) and Cohort 2 (365 STEMI patients, 2018-2020 post-UHC), this study employed the chi-square test to determine differences between genders and the Kaplan–Meier log-rank test to compare survival rates. Results Comparing pre- and post-UHC, we observed a significant increase in both medication and reperfusion therapy (p&amp;lt;0.001). However, even in both periods, women continued to have lower rates of medication and reperfusion compared to men (Men vs Women: Before UHC 14.3% vs 0%; After UHC 58.5% vs 47.9%). Within 30 days after the STEMI event, we noted a reduction in mortality rates across genders before and after UHC implementation, yet the decrease was less pronounced in women compared to men (Before UHC: Men 13.0%, Women 22.0%; After UHC: Men 8.2%, Women 18.3%). Conclusion UHC led to improvements in medication and reperfusion therapy for STEMI patients. Despite this progress, persistent gender disparities were observed, with women consistently having lower treatment rates. While mortality rates reduced for both genders, the decrease was less pronounced in women, especially after the implementation of UHC. These findings emphasize the need for targeted interventions to address gender-specific healthcare discrepancies within the scope of comprehensive health coverage.Baseline characteristicsMortality outcomes within 30 Days

Prognosticating short-term outcomes in STE-ACS patients with intra-procedure slow flow/no-reflow: an analysis of predictive factors in primary percutaneous coronary revascularization

Abstract Background "ST-segment elevation myocardial infarction (STEMI)" is the most lethal form of "ischemic heart disease (IHD).primary "percutaneous coronary intervention (PCI)" as the first-line treatment for STEMI patients, as it offers better outcomes compared to other medical or surgical options [1,2]. One major concern in interventional cardiology is the occurrence of "slow flow/no-reflow (SF/NR)", which refers to the poor myocardial perfusion to the infarct-related artery as a result of microvascular obstruction. Objectives In this study, we compared the incidence of short-term outcomes between two groups of patients based on the occurrence of intra-procedure "slow flow/no-reflow (SF/NR)" and identified predictors of short-term outcomes. Method This study enrolled a series of consecutive patients who underwent primary "percutaneous coronary intervention (PCI)" for "ST-elevation myocardial infarction (STEMI)". The patients who developed SF/NR during the procedure were compared with their counterparts for the incidence of short-term "major adverse cardiovascular events (MACE)". Furthermore, the study aimed to identify predictors of short-term mortality in these patients. Result In this study, a total of 2,582 patients were included. Among them, 79.1% (2,042) were male. The average age of the patients was 55.7 ± 11.2 years. Intra-procedure SF/NR was observed in 21.7% (560) of the patients. During median short-term follow-up of 180 [144-205] days, patients with SF/NR exhibited higher incidence of all-cause mortality (23.6% vs. 12.3%; p&amp;lt;0.001), and MACE (30.4% vs. 16.9%; p&amp;lt;0.001) with hazard ratio of 1.82 [1.46-2.27; p&amp;lt;0.001] and 1.69 [1.39-2.05; p&amp;lt;0.001], respectively. Among patients with SF/NR, adjusted odds ratio for total ischemic time: 1.04 [1.00-1.07; p=0.041], random blood sugar levels: 1.01 [1.00-1.01; p&amp;lt;0.001], intubation status: 2.79 [1.26-6.18; p=0.011], post-procedure sub-optimal flow: 1.76 [1.04-2.98; p=0.034], and intra-procedural arrhythmias: 5.48 [2.03-14.79; p&amp;lt;0.001] were found to be independent predictors of short-term mortality. Conclusion In conclusion, the presence of intra-procedure SF/NR carries significant prognostic implications. Patients with intra-procedure SF/NR face a significantly higher risk of short-term adverse outcomes.

Right ventricular dysfunction parameters at echocardiography in patients with acute pulmonary embolism: meta-analysis of individual participant data

Abstract Background &amp; Aim Echocardiography has a crucial role for decision making on management of patient with acute pulmonary embolism (PE) according to current international guidelines. However, the definition of right ventricle dysfunction (RVD) at echocardiography requires standardization. We performed an Individual patient data meta-analysis (IPDMA) to assess the role of individual parameters of RVD and of combinations of parameters for the prediction of short-term all-cause mortality and PE-related death. Methods A systematic search was run to identify clinical studies reporting on RVD at echocardiography and on short-term clinical outcome in patients with acute PE. Individual patient data from the original studies were pooled to perform a meta-analysis (IPDMA). The study outcomes were short-term death defined as death occurring within 30 days from PE diagnosis and PE-related death. Multiple imputation was used for the management of missing data. The odds ratio for all cause and PE related mortality were calculated using generalized linear mixed effects model. Results Individual data from 9,233 patients with acute PE from 16 studies were pooled in a unique database. All cause short-term mortality occurred in 9% of patients (95% CI 0.06-0.13, I2 93%). The IPDMA was feasible for the following parameters: tricuspid anulus systolic excursion (TAPSE), estimated pulmonary artery pressure (PAP) &amp;gt;30mmHg, right to left ventricle diameter ratio (RV/LV)&amp;gt;1, hypokinesia, paradoxical septal motion, RV diameter&amp;gt;30 mm and McConnel sign. All these parameters, except for PAP&amp;gt;30mmHg and RV diameter&amp;gt;30 mm, were predictors of short-term all cause death in the overall population and in hemodynamically patients (table). All the assessed RV findings, except for the McConnell’s sign, were predictors of PE-related death (Table). The presence of one RVD parameter only was not associated with increased risk of all cause death (OR 1.22, 95% CI 0.97-1-54), while the presence of two parameters or ≥ three parameters were (OR 1.63, 95% CI 1.24-2.15; OR 2.07 95% CI 1.59-2.69, respectively). Conclusion In patients with acute PE, the majority of RVD parameter at echocardiography are predictors of short-term death and of PE-related death. The higher the number of RVD parameters the worst the prognosis. These results claim for standardization in RVD definition to guide decision making for patient management.

The Impact of Blood Pressure Rhythm and Perioperative Blood Pressure Variability on Short-Term Prognosis in Patients with Type A Aortic Dissection.

Aims/Background Previous studies have indicated a strong correlation between disturbances in blood pressure (BP) circadian rhythm and major cardiovascular adverse events. Similarly, blood pressure variability (BPV) has been closely linked to cerebral small vessel disease and leukoaraiosis. This study aims to investigate the relationship between BP rhythm and BPV with the short-term prognosis of patients with Type A aortic dissection, offering insights for targeted perioperative nursing interventions and improving patient outcomes. Methods This retrospective study included patients undergoing surgical treatment for Type A aortic dissection at Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences) from June 2022 to March 2024. The study followed patients from the completion of surgery to 30 days postoperatively, with all-cause mortality within 30 days as the endpoint representing poor short-term prognosis. Clinical data were compared along with: types of BP rhythm; BPV parameters including the mean 24-hour systolic BP (24hSBP), 24-hour diastolic BP (24hDBP), and pulse pressure; and the coefficient of variability (CV) for 24hSBP, 24hDBP, and pulse pressure. Multivariate logistic regression analysis was utilized to identify risk factors for poor short-term outcomes in these patients, and receiver operating characteristic (ROC) curves were plotted to assess the predictive value of BP rhythm types and BPV indicators. Results The study ultimately included 115 participants, with 31 deaths occurring within 30 days post-surgery, resulting in a postoperative mortality rate of 26.96%. The multivariate logistic regression analysis revealed that white blood cell count, neutrophil count, non-dipping BP rhythm, pulse pressure, and the CV for 24hSBP, 24hDBP, and pulse pressure, were significant risk factors for poor short-term prognosis (p < 0.05). The ROC curve analysis demonstrated that non-dipping BP rhythm, pulse pressure, 24hSBP-CV, 24hDBP-CV, and pulse pressure-CV had areas under the curve (AUC) of 0.685, 0.749, 0.751, 0.773, and 0.763, respectively. The combination of these indicators yielded the highest AUC at 0.918. Conclusion A combination of BP rhythm and BPV indicators provides significant predictive value for poor short-term outcomes in patients with Type A aortic dissection. Clinicians and nursing staff can use these features to formulate targeted preventive measures.

44 Spotting the clotting: a 3-year national surveillance study of paediatric pulmonary thromboembolism

Abstract Background Pulmonary thromboembolism (PE) is a rare event in the paediatric population but can be acutely life-threatening and result in chronic complications. Awareness of contemporary patterns of clinical presentation, diagnostic modalities, and management may aid clinicians in ensuring that patients are promptly identified and treated. Objectives To describe the risk factors, symptoms, diagnostic modalities, therapeutic interventions, and short-term outcomes in paediatric patients (neonate up to 18 years) with PE through national surveillance. Design/Methods Between January 2020 and December 2022, monthly surveillance was conducted with over 2,800 paediatricians and sub-specialists through the Canadian Paediatric Surveillance Program. Voluntary reporting of cases meeting a standardized definition of PE was followed up with a detailed questionnaire. Results 58 confirmed cases were reported; 33 (57%) were females age 15 to 18 years. Detailed information was available for 31 (53%) of 58 cases. At least 1 risk factor was identified in 28 (90%) cases and 12 (39%) patients had 2 or more risk factors. The most common risk factors were oral contraceptive use (n=10 of 31; 32%) and obesity (n=9 of 31; 29%). Presentation was symptomatic in 28 (90%) cases; 24 (77%) patients presented with 2 or more symptoms. The most common symptoms were chest pain (n=18; 58%), dyspnea (n=13; 42%) and tachycardia (n=13; 42%). The most common diagnostic modality utilized was computed tomography pulmonary angiography (n=25; 81%). Initiation of systemic anticoagulation was reported for 24 (77%) of 31 cases; thrombolysis and surgical interventions were uncommon (&amp;lt; 5 cases). Treatment complications were common (n=8; 29%). Mortality was reported, but in fewer than 5 cases. Conclusion PE in children often presents with non-specific symptoms, but usually occurs in patients with known risk factors. Clinicians should maintain a high index of suspicion in symptomatic patients, particularly those with risk factors and in cases when other diagnoses that may explain symptoms have been excluded. Anticoagulation is the mainstay of treatment; complications can occur. Prompt recognition and management presumably reduce morbidity and mortality, but this cannot be inferred from our data.

Short-Term Outcomes in Patients With Coexistence of COVID-19 Infection and Vitamin D Deficiency: A Large Cohort Study

Short-Term Outcomes in Patients With Coexistence of COVID-19 Infection and Vitamin D Deficiency: A Large Cohort Study

Short-term Clinical Outcomes of COVID-19 Patients Hospitalized with Chronic Obstructive Pulmonary Disease and Asthma in Three Tertiary Level Hospitals in Bangladesh

Background: Several comorbidities including chronic obstructive pulmonary disease (COPD) or bronchial asthma have been found associated with COVID-19 cases. But it remains unclear which of the comorbidities are associated with worse outcomes of the patients. Objectives: This study was carried out to determine the clinical outcomes of hospitalized COVID-19 patients with COPD or asthma. Methodology: This prospective study was carried out at Respiratory Medicine unit of Monno Medical College and Hospital, Manikganj, from April 2020 to December 2022. Admitted COVID-19 patients, suffering from COPD or bronchial asthma, were enrolled purposively upon fulfilling the inclusion and exclusion criteria. The patients were divided into two groups with associated comorbidities: Group A suffering from COPD and Group B suffering from Asthma. Data were collected from the patients on variables of interest using a semi-structured questionnaire. Results: Among the 144 enrolled patients, 96(66.67%) in group A were suffering from COPD and the other 48 (33.33%) in group B had bronchial asthma. In this study, 41(42.7%) patients in Group A exhibited &gt;25% lung field involvement in the high-resolution computed tomography (CT) chest imaging, compared to only 10(20.8%) in COVID-19 patients in Group B, and this difference in distribution was statistically significant (p=0.026). The COVID-19 patients in Group A were more severe to critically ill (45, 46.9%), compared to patients in Group B (12, 25.0%) with a p value of 0.011. Group A study subjects required intensive care unit (ICU) admission (49, 51.0%) more than the group B participants (16, 33.3%), which was also found statistically significant (p&lt;0.05). Nearly one-fifth (17, 17.7%) of the patients died among the Group A, compared to only 2(4.2%) mortality observed in Group B (p=0.024). The COVID-19 patients with COPD were found significantly associated with the risk of &gt;25% lung field involvement, severe to critical illness, ICU admission, invasive mechanical ventilation, and death (all p values &lt;0.05). Conclusion: The comorbidity of COPD was found to increase the risk of disease severity and adverse outcomes in COVID-19patients significantly. It also heightened the risk of lung field involvement, exceeding 25% more severe disease and increased mortality rates compared to individuals with bronchial asthma. Journal of Monno Medical College December, 2023; 9 (2):47-52

Predicting 3-month poor functional outcomes of acute ischemic stroke in young patients using machine learning

BackgroundPrediction of short-term outcomes in young patients with acute ischemic stroke (AIS) may assist in making therapy decisions. Machine learning (ML) is increasingly used in healthcare due to its high accuracy. This study aims to use a ML-based predictive model for poor 3-month functional outcomes in young AIS patients and to compare the predictive performance of ML models with the logistic regression model.MethodsWe enrolled AIS patients aged between 18 and 50 years from the Third Chinese National Stroke Registry (CNSR-III), collected between 2015 and 2018. A modified Rankin Scale (mRS) ≥ 3 was a poor functional outcome at 3 months. Four ML tree models were developed: The extreme Gradient Boosting (XGBoost), Light Gradient Boosted Machine (lightGBM), Random Forest (RF), and The Gradient Boosting Decision Trees (GBDT), compared with logistic regression. We assess the model performance based on both discrimination and calibration.ResultsA total of 2268 young patients with a mean age of 44.3 ± 5.5 years were included. Among them, (9%) had poor functional outcomes. The mRS at admission, living alone conditions, and high National Institutes of Health Stroke Scale (NIHSS) at discharge remained independent predictors of poor 3-month outcomes. The best AUC in the test group was XGBoost (AUC = 0.801), followed by GBDT, RF, and lightGBM (AUCs of 0.795, 0, 794, and 0.792, respectively). The XGBoost, RF, and lightGBM models were significantly better than logistic regression (P < 0.05).ConclusionsML outperformed logistic regression, where XGBoost the boost was the best model for predicting poor functional outcomes in young AIS patients. It is important to consider living alone conditions with high severity scores to improve stroke prognosis.

Prenatal Detection of D-TGA and Novel Interventional Program Decrease Time to Balloon Septostomy.

Infants with dextro-transposition of the great arteries (d-TGA) are at high risk for hemodynamic compromise in the immediate postnatal period due to dependence on intracardiac mixing for oxygen delivery. This period of profound hypoxemia may have long-term implications, as previous studies demonstrated patients with d-TGA are at increased risk for neurocognitive delays despite effective surgical correction in the neonatal period. Balloon atrial septostomy (BAS) is an established intervention that improves intracardiac mixing and perioperative hemodynamics. This retrospective study aimed to quantify the time from birth to BAS and compare short-term outcomes for patients with prenatal and postnatal diagnoses of d-TGA. We identified 68 newborns born with d-TGA who were admitted to our facility between 2013 and 2022 and required BAS within 48h after birth. Halfway through this study, our cardiac interventional team began traveling to a nearby delivery center where a bedside BAS could be performed prior to transferring the patient. We divided the patients into 3 groups-postnatal diagnosis (n = 27), prenatal diagnosis with rapid transport (n = 24), and prenatal diagnosis with interventional team performing a BAS at the delivery hospital (n = 17). The time from birth to BAS was significantly shorter for patients in the interventional program group (1.1h) compared to the rapid transport (4.5h) and postnatal diagnosis groups (9.3h, p value < 0.01). The interventional program group also had lower lactate levels and less acidotic pH compared to the other groups. There was no significant difference in lowest oxygen saturation level, pre-surgical neurologic complication rate, time to surgery, or hospital length of stay. The interventional program proved to be a safe and effective model, as there were no procedural complications and the time to BAS decreased. Long-term follow-up is needed to determine if abating this initial period of hemodynamic instability will lead to improved neurodevelopmental outcomes.

Last minute cancellation of elective lung cancer surgery is associated with poorer survival.

Our objective was to assess the incidence and reason of last-minute cancellations before surgery for lung cancer and their association with outcomes. Retrospective analysis on all consecutive patients booked for elective lung cancer surgery from January 2017 through December 2022 in a single centre.Last minute cancellation: a cancellation occurring within the last 24 hours from the planned operation. Cancellation categories: process-related and patient-related.The short-term and long-term outcomes of patients who experienced a last-minute cancellation were analysed. 197 patients of 1587 (12%) had a last-minute cancellation: 156 (79%) were process-related and 41 (21%) were patient-related.3% (5/156) of patients cancelled for process reasons did not receive surgery vs 39% (16/41) of those cancelled for patient-related reasons, p < 0.0001.The 90-day mortality rates of cancelled and non-cancelled patients were similar (4.6% vs 4.7%, p = 1).Five-year overall survival of patients with cancellation was 58% (95% CI 49-66) vs 69% (95% CI 66-71) of those without cancellations, p = 0.022.Among those who had a cancellation, the 5-year OS of those with process-related cancellations was 61% (52-60) vs 35% (14-58) of those with patient-related cancellations (adjusted p value for multiple comparisons = 0.14).Cox regression analysis showed that surgery cancellations within the last 24 hours for patient-related (HR 1.87, 95% CI 1.02-3.42, p = 0.043) reasons remained a factor associated with poorer overall survival after adjusting for clinical stage, type of operation and patient related variables. Implementing the patient's preoperative clinical evaluation to reduce the occurrence of related last-minute cancellations might mitigate its negative impact on survival.

TCT-985 Gender and Racial Disparities in Patients With Systemic Sclerosis: Short-Term Outcomes of Patients With Acute Coronary Syndrome

TCT-985 Gender and Racial Disparities in Patients With Systemic Sclerosis: Short-Term Outcomes of Patients With Acute Coronary Syndrome

The short-term outcomes and risk factors of post-myocardial infarction ventricular septal rupture: a multi-center retrospective Study

ObjectivesPost-myocardial infarction ventricular septal rupture (PIVSR) is one of the most severe types of mechanical complications after acute myocardial infarction (AMI) with high mortality and poor prognosis. The risk factors for short-term mortality of patients with PIVSR may be not widely recognized. We aimed to assess the prevalence and short-term mortality risk predictors of PIVSR.MethodsA total of 62 patients with a diagnosis of PIVSR were admitted to three top general public hospitals in Chongqing, China. Clinical characteristics and short-term outcomes of patients with PIVSR were compared. Predictors of PIVSR were assessed using logistic regression analysis.ResultsMean age was 70.7 ± 10.7 years (38.7% female). The overall in-hospital mortality of PIVSR remained high (71%). Most (47/62) of the patients were in Killip class III or IV at the time of rupture diagnosis. Logistic regression analysis revealed that white blood cell count (WBC, OR 1.619, 95% CI 1.172–2.237, P = 0.005), cardiogenic shock (OR 47.706, 95%CI 2.859-795.945, P = 0.007) and left ventricular ejection fraction (LVEF, OR 0.803, 95%CI 0.689–0.936, P = 0.009) were independent risk factors of in-hospital early mortality. The nomogram developed for predicting the risk of short-term mortality showed a robust discrimination, with an area under the receiver operating characteristic curve (AUC) of 0.956 (95%CI 0.912-1.000).ConclusionThe short-term mortality of PIVSR remained high. WBC, cardiogenic shock, and LVEF were the independent predictive factors of short-term mortality. Our nomogram might be used to predict early mortality of patients with PIVSR.

Morphological characteristics of CT blend sign predict hematoma expansion and outcomes in intracerebral hemorrhage in elderly patients.

The underlying basis of the blend sign on brain computed tomography (CT) in patients with intracerebral hemorrhage (ICH) is unclear. Few studies have examined the morphological alterations in the CT blend sign in ICH. Therefore, we assessed changes in the CT blend sign and their association with hematoma expansion (HE) and adverse outcomes in ICH patients. We recorded the clinical and radiographic parameters of patients with ICH and blend sign on brain CT. The patients were categorized into two groups, with changes in the relatively hypoattenuating region of the blend sign (CHB group) and with no changes in the relatively hypoattenuating region of the blend sign (NHB groups). We performed univariate and multivariate logistic regression analyses to examine the correlations between CHB and HE and poor outcomes. Furthermore, receiver operating characteristic curve analysis was used to confirm the predictive power of CHB. In total, 183 patients were included in the study, of whom 74 (40.4%) demonstrated changes in the hypoattenuating region of the blend sign, whereas 109 (59.6%) did not. Compared with the NHB group, patients in the CHB group exhibited significantly higher levels of HE and adverse outcomes. After adjustment for confounding factors, CHB was independently associated with HE (odds ratio, 19.401 [95% CI, 7.217-52.163]; p < 0.001) and poor 3-month outcomes (odds ratio, 2.638 [95% CI, 1.391-5.003]; p = 0.003) in the multivariate analysis. The sensitivity, specificity, positive predictive value, and negative predictive value of CHB for predicting HE were 0.877, 0.768, 0.791, and 0.862, respectively, whereas these values for predicting poor outcomes were 0.789, 0.641, 0.688, and 0.752, respectively. Changes of a hypoattenuating region within the blend sign have good predictive accuracy for HE and short-term adverse outcomes in elderly patients with ICH. ClinicalTrials.gov, NCT05548530.