Significant Predictor Of Death Research Articles

In-hospital mortality patterns and risk factors in patients with cancer with COVID-19.

e23070 Background: The current body of knowledge regarding outcomes of patients with cancer and COVID-19 is conflicting, with some studies suggesting worsened mortality in those with both diseases This study seeks to shed light on the distinctive factors influencing in-hospital mortality in these two cohorts, providing crucial insights that can guide targeted interventions and enhance healthcare strategies for individuals facing the dual burden of cancer and COVID-19. Methods: We conducted a retrospective review of all patients hospitalized with COVID-19 at our institution between January 1, 2021 and April 1, 2023. Patients were stratified into a cohort of those with cancer and coexisting COVID-19 infection and those with solely COVID-19. The cancer and COVID-19 cohort included patients over the age of 18 who had received treatment for cancer within the last 6 months. Information regarding patient demographic characteristics and comorbidities, as well as in-hospital treatment characteristics and outcomes. We performed descriptive analysis and conducted Chi-squared and t-tests to assess for differences in baseline characteristics between cohorts, then developed Cox proportional hazards models to evaluate risk factors for in-hospital mortality. Results: 456 patients with cancer and COVID-19 were compared with 12,566 patients with only COVID-19. In-hospital mortality was 8.2% in the cancer cohort compared with 9.0% in the COVID-19 only cohort. Patients in the cancer cohort were more likely to be male (55.7% vs 48.2%, p = 0.004), older (71 vs 64 years, p < 0.001) with histories of heart failure (27% vs 21%, p = 0.002), chronic kidney disease (50% vs 39%, p < 0.001), COPD (35% vs 24%, p < 0.001), and anemia (57% vs 24%, p < 0.001). The cancer cohort experienced significantly longer length of stay (9 vs 7 days, p < 0.001). Requirement of mechanical ventilation and ICU stay were similar between groups. Multivariate Cox proportional hazards ratios demonstrated similar mortality between cohorts (HR = 0.863, p = 0.361), with age (HR = 1.041, p < 0.001) and history of acute myocardial infarction (HR = 1.275, p = 0.01) being significant predictors of death. Conclusions: Our study demonstrates the complex relationship between cancer, COVID-19, and in-hospital mortality. Despite differences in baseline characteristics between the cohorts, our findings reveal that, after adjusting for confounding factors, there is no significant disparity in mortality rates between patients concurrently battling cancer and COVID-19 and those solely afflicted by COVID-19. The identification of age and a history of acute myocardial infarction as significant predictors of mortality underscores the need for targeted interventions and vigilant management strategies for individuals facing the dual burden of cancer and COVID-19, ensuring equitable and effective healthcare outcomes in this complicated patient population.

The Role of Routine Electroencephalography in the Diagnosis of Seizures in Medical Intensive Care Units.

Seizures should be diagnosed and treated to ensure optimal health outcomes in critically ill patients admitted in the medical intensive care unit (MICU). Continuous electroencephalography is still infrequently used in the MICU. We investigated the effectiveness of routine EEG (rEEG) in detecting seizures in the MICU. A total of 560 patients admitted to the MICU between October 2018 and March 2023 and who underwent rEEG were reviewed. Seizure-related rEEG constituted 47% of all rEEG studies. Totally, 39% of the patients experienced clinical seizures during hospitalization; among them, 48% experienced the seizure, and 13% experienced their first seizure after undergoing an rEEG study. Seventy-seven percent of the patients had unfavorable short-term outcomes. Patients with cardiovascular diseases were the most likely to have the suppression/burst suppression (SBS) EEG pattern and the highest mortality rate. The rhythmic and periodic patterns (RPPs) and electrographic seizure (ESz) EEG pattern were associated with seizures within 24 h after rEEG, which was also related to unfavorable outcomes. Significant predictors of death were age > 59 years, the male gender, the presence of cardiovascular disease, a Glasgow Coma Scale score ≤ 5, and the SBS EEG pattern, with a predictive performance of 0.737 for death. rEEG can help identify patients at higher risk of seizures. We recommend repeated rEEG in patients with ESz or RPP EEG patterns to enable a more effective monitoring of seizure activities.

#1105 Prognosis of dialysis patients with obstructive sleep apnea syndrome diagnosed by polysomnography

Abstract Background and Aims Obstructive Sleep Apnea Syndrome (OSA) is common among CKD, in particular dialysis patients. However, it is not yet studied in a large polysomnography (PSG) database. Randomized controlled trials (RCTs) proved the effectiveness of continuous positive airway pressure (CPAP) for the SAS-related symptoms, but not for lowering the mortality risk of all-cause and cardiovascular disease. However, the effect of CPAP on mortality risk is not examined among dialysis patents. Method We identified dialysis patients by reviewing medical records in the Okinawa Nakamura Clinic (ONSLEEP). (J Clin Sleep Med 2021). In the ONSLEEP, a total of 10,856 Japanese patients received PSG from September 1990 to December 2010. We defined patients who were on CPAP more than one month as CPAP user. Patients qualified and eligible for CPAP but refused it were assigned as CPAP non-users. Median observation was 6.6 years. We studied 9,841 PSG patients after excluding those with insufficient data, age<20 years, and central SAS. Among them, we found 195 dialysis patients: 16 (1.0%) dialysis patients with AHI<5/hour in 1,665 subjects and 164 (2.5%) in 8,176 OSA patients. Mortality rate was compared between CPAP users and nonusers by multivariate logistic analysis adjusted for age, gender, body mass index (BMI), and apnea hypopnea index (AHI). Results Among the OSA dialysis patients (men 127, women 37), there were 116 (2.6%) in the CPAP users and 48 (2.2%) in the CPAP non-users, respectively. Number of deaths was 65 (39 CPAP users, 26 CPAP non-users) during the follow-up. The death rate was 33.6% in the CPAP users and 54.2% in the CPAP non-users, respectively. CPAP users showed better survival after starting dialysis; hazard ratio (HR) 0.52 and 95% confidence interval (CI) of 0.31 to 0.88 (P = 0.015). Age was also a significant predictor of death; HR (95% CI) 1.04 (1.02-1.06, P < 0.0001). Conclusion Dialysis patients with OSA showed better survival by use of CPAP. In dialysis patients, screening of OSA is recommended if they complained sleep problems such as insomnia, daytime sleepiness, headache, and fatigue. Also, we need further study for those CPAP nonusers.

Frequent Disengagement and Subsequent Mortality Among People With HIV and Hepatitis C in Canada: A Prospective Cohort Study.

The cascade of care, commonly used to assess HIV and hepatitis C (HCV) health service delivery, has limitations in capturing the complexity of individuals' engagement patterns. This study examines the dynamic nature of engagement and mortality trajectories among people with HIV and HCV. We used data from the Canadian HIV-HCV Co-Infection Cohort, which prospectively follows 2098 participants from 18 centers biannually. Markov multistate models were used to evaluate sociodemographic and clinical factors associated with transitioning between the following states: (1) lost-to-follow-up (LTFU), defined as no visit for 18 months; (2) reengaged (reentry into cohort after being LTFU); (3) withdrawn from the study (ie, moved); (4) death; otherwise remained (5) engaged-in-care. A total of 1809 participants met the eligibility criteria and contributed 12 591 person-years from 2003 to 2022. LTFU was common, with 46% experiencing at least 1 episode, of whom only 57% reengaged. One in 5 (n = 383) participants died during the study. Participants who transitioned to LTFU were twice as likely to die as those who were consistently engaged. Factors associated with transitioning to LTFU included detectable HCV RNA (adjusted hazards ratio [aHR], 1.37; 95% confidence interval [CI], 1.13-1.67), evidence of HCV treatment but no sustained virologic response result (aHR, 1.99; 95% CI, 1.56-2.53), and recent incarceration (aHR, 1.94; 95% CI, 1.58-2.40). Being Indigenous was a significant predictor of death across all engagement trajectories. Disengagement from clinical care was common and resulted in higher death rates. People LTFU were more likely to require HCV treatment highlighting a priority population for elimination strategies.

Hubungan Hipertensi Terhadap Kematian Pasien Covid-19 Dengan Diabetes Melitus Tipe 2 di RSUP dr. Sardjito

Diabetes mellitus and hypertension are co-morbidities that are often found in COVID-19 patients. Diabetes can reduce the body's immunity and increase the rate of viral replication, and is associated with vascular problems. Hypertension is one of the comorbid diabetes with high morbidity and mortality. To determine the relationship between hypertension and the death of COVID-19 patients with type 2 diabetes mellitus at Dr Sardjito General Hospital. Observational study with a retrospective cohort study design, using COVID-19 registry data at Dr Sardjito General Hospital for the period March 2020-July 2021. COVID-19 patients with type 2 diabetes mellitus who had hypertension and those who did not have hypertension were selected at Dr Sardjito General Hospital and Collected data on mortality, age, sex, other comorbidities, severity and length of stay. Data were processed using SPSS, in univariate, bivariate, and multivariate analysis models. the results of multivariate analysis using logistic regression found that hypertension, age, and ischemic heart disease did not have a significant association with the death of COVID-19 patients with type 2 diabetes mellitus. The variable that had the greatest power as a predictor of death in COVID-19 patients with diabetes mellitus type 2 is ARDS with a risk of death 20.8 times higher than without ARDS. Patients with kidney failure are at risk of dying 2.7 times higher than those without kidney failure. The addition of length of stay (LOS) 1 day of treatment reduces the risk of death by 16.3%. Hypertension has no significant relationship as a predictor of death in COVID-19 patients with type 2 diabetes mellitus at Dr Sardjito General Hospital. Significant predictors of death in this study were ARDS, kidney failure, and were associated with length of stay (LOS).

Long-term survival in patients with brain-only metastatic non-small cell lung cancer undergoing upfront intracranial stereotactic radiosurgery and definitive treatment to the thoracic primary site

Background and purposeTo evaluate modern clinical outcomes for patients with brain-only metastatic non-small cell lung cancer (NSCLC) treated with intracranial stereotactic radiosurgery (SRS) with or without definitive treatment of the primary site. Materials and methodsPatients with synchronously diagnosed NSCLC and brain-only metastatic disease treated with intracranial SRS at a single institution were retrospectively identified. Patients were stratified based on whether they did (A) or did not (B) receive definitive primary site treatment. Patient characteristics and clinical outcomes were compared. ResultsFrom 2008 to 2022, 103 patients were identified, 53 of whom received definitive primary site treatment. Median follow-up was 2.1 y (A) and 0.8 y (B) (p < 0.001). 28 (53 %) patients in Group A received immune checkpoint inhibitor (ICI) therapy versus 19 (38 %) in Group B (p = 0.13) and there were no other statistically significant baseline or treatment characteristic differences between the groups. 5-year local-PFS was 34.5 % (A) versus 0 % (B) (p < 0.001). 5-year regional-PFS was 33.0 % (A) versus 0 % (B) (p < 0.001). 5-year distant body-PFS was 34.0 % (A) versus 0 % (B) (p < 0.001). 5-year CNS-PFS was 14.7 % (A) versus 0 % (B) (p = 0.12). 5-year OS was 40.2 % (A) versus 0 % (B) (p = 0.001). 5-year CSS was 67.6 % (A) versus 0 % (B) (p = 0.002). On multivariable analysis, lack of definitive treatment to the primary site (HR = 2.40), AJCC T3-4 disease (HR = 2.73), and lack of ICI therapy (HR = 2.86) were significant predictors of death. ConclusionDefinitive treatment to the thoracic primary site in patients with brain-only metastatic NSCLC after intracranial radiosurgery was associated with slower progression of disease and improved survival.

Association of echocardiography-related parameters with the prognosis of decompensated cirrhosis: a retrospective cohort study

Background Cardiac morphology and function, which are conventionally evaluated by echocardiography, are often abnormal in decompensated cirrhosis. We aimed to evaluate the association of echocardiography-related parameters with prognosis in cirrhosis. Methods This retrospective study included 104 decompensated cirrhotic patients, in whom cardiac structure and function were measured by echocardiography, including mitral inflow early diastolic velocity/mitral inflow late diastolic velocity (E/A), left atrium diameter, left ventricular end-diastolic dimension, interventricular septal thickness, left ventricular posterior wall thickness, right atrial transverse diameter, right atrial longitudinal diameter, right ventricular dimension (RVD), stroke volume, cardiac output, left ventricular ejection fraction, and fractional shortening. Cox regression and competing risk analyses and Kaplan-Meier and Nelson-Aalen cumulative risk curves were used to evaluate their associations with further decompensation and death in cirrhotic patients, if appropriate. Results Lower RVD was a predictor of further decompensation in Cox regression (adjusted by Child-Pugh score: p = 0.138; adjusted by MELD score: p = 0.034) and competing risk analyses (p = 0.003), and RVD ≤17 mm was significantly associated with higher cumulative incidence of further decompensation in Kaplan-Meier (p = 0.002) and Nelson-Aalen cumulative risk curves (p = 0.002). E/A ≤ 0.8 was a significant predictor of death in Cox regression (adjusted by Child-Pugh score: p = 0.041; adjusted by MELD score: p = 0.045) and competing risk analyses (p = 0.024), and E/A ≤ 0.8 was significantly associated with higher cumulative incidence of death in Kaplan-Meier (p = 0.023) and Nelson-Aalen cumulative risk curves (p = 0.024). Other echocardiography-related parameters were not significantly associated with further decompensation or death. Conclusion RVD and E/A may be considered for the prognostic assessment of decompensated cirrhosis.

Abstract TMP80: Hematoma Radiomic Markers of Survival After Supratentorial Intracerebral Hemorrhage on Admission Non-Contrast Head CT

Background: Radiomic features provide quantitative information about lesions morphology and texture on medical images. Recent studies have shown that intracerebral hemorrhage (ICH) radiomics on admission non-contrast head CT are associated with severity of symptoms at baseline and clinical outcomes - providing prognostic information beyond hematoma volume. In this study, we determined hematoma radiomic markers of post-ICH survival on admission head CT. Methods: Using the ATACH-2 trial dataset, we manually segmented ICH on admission head CTs and extracted 1130 radiomic features. Univariate and multivariate survival analyses were performed using the Cox Proportional Hazards model, Kaplan Meier Analysis, and logistic regression. Results: We split our dataset (n=871) to training (n=580) and testing (n=291) cohorts. Increased “original first order Energy” radiomic feature was associated with a higher probability of death (Hazard Ratio=1.64, p &lt;0.0001). LASSO Cox Proportional Hazards modeling also identified “original first order Energy” alongside age, NIHSS, and baseline INR as significant predictors of death. The ROC analysis confirmed the prognostic capability of this feature at 7 days, 30 days, and 90 days post-ICH in training and test cohorts. Kaplan Meier analysis demonstrated that increased “original first order Energy” is associated with a higher probability of death (p &lt; 0.05 at all time points). Logistic regression also showed that this feature is an independent predictor of post-ICH mortality (Odds ratios=2.04, p &lt; 0.001). Conclusions: The “original first order Energy” radiomic feature of hematoma on admission non-contrast head CT scans is a main predictor of survival in supratentorial ICH. This radiomic feature represents the magnitude of voxel values confounded with lesion volume - i.e. brighter larger hematomas on head CT have higher " original first order Energy ", and are associated with higher mortality rates after supratentorial ICH.

The Association of Post-Lung Transplant Pulmonary Embolism With the Development of Chronic Lung Allograft Dysfunction.

Pulmonary embolism (PE) is a rare yet serious postoperative complication for lung transplant recipients (LTRs). The association between timing and severity of PE and the development of chronic allograft lung dysfunction (CLAD) has not been described. A single-center, retrospective cohort analysis of first LTRs included bilateral or single lung transplants and excluded multiorgan transplants and retransplants. PEs were confirmed by computed tomography angiography or ventilation/perfusion (VQ) scans. Infarctions were confirmed on computed tomography angiography by a trained physician. The PE severity was defined by the Pulmonary Embolism Severity Index (PESI) score, a 30-d post-PE mortality risk calculator, and stratified by low I and II (0-85), intermediate III and IV (85-125), and high V (>125). PE and PESI were analyzed in the outcomes of overall survival, graft failure, and chronic lung allograft dysfunction (CLAD). We identified 57 of 928 patients (6.14%) who had at least 1 PE in the LTR cohort with a median follow-up of 1623 d. In the subset with PE, the median PESI score was 85 (75.8-96.5). Most of the PESI scores (32/56 available) were in the low-risk category. In the CLAD analysis, there were 49 LTRs who had a PE and 16 LTRs (33%) had infarction. When treating PE as time-dependent and adjusting for covariates, PE was significantly associated with death (hazard ratio [HR] 1.8; 95% confidence interval [CI], 1.3-2.5), as well as increased risk of graft failure, defined as retransplant, CLAD, or death (HR 1.8; 95% CI, 1.3-2.5), and CLAD (HR 1.7; 95% CI, 1.2-2.4). Infarction was not associated with CLAD or death. The PESI risk category was not a significant predictor of death or CLAD. PE is associated with decreased survival and increased hazard of developing CLAD. PESI score was not a reliable predictor of CLAD or death in this lung transplant cohort.

Predictors of COVID-19 outcome in type 2 diabetes mellitus: a hospital-based study

Abstract Background Diabetes has become a significant risk factor for COVID-19-related severe illness and death. Methods This was a retrospective cohort study of 104 patients, with or without type 2 (diabetes mellitus) DM, diagnosed with COVID-19 between June and September 2021 in Benha University Hospital, Egypt. Outcome measures including discharge after recovery, transfer to ICU and intubation, or death were recorded. Univariate and multivariate logistic regression analysis was done for the prediction of death in diabetic patients. Results Length of hospital stay was significantly higher in diabetic (median 15 days) compared to non-diabetic patients (median 10 days). ICU admission and intubation among diabetic patients were substantially higher than non-diabetics. Univariate regression analysis established that old age (p = 0.02: OR = 1.03: CI 1.00–1.07), multiple comorbidities (p = 0.005: OR = 8.66: CI 1.9–38.5), diabetic complications (p = 0.000: OR = 6.401:CI 2.5–16.3), HbA1c (p = 0.01: OR = 1.22: CI 1.04–1.43), length of hospital stay (p = 0.005: OR = 1.07: CI 1.02–1.12), and ICU admission (p = 0.00: OR = 44.1: CI 9.4–205.3) were predictors of death for diabetic patients as well as neutrophilic count, D-dimer, and CRP levels. Multivariate regression analysis concluded that ICU admission was the most significant predictor of death in diabetic patients. Conclusion Type 2 DM patients, infected with the COVID-19 virus exhibited more admission to ICU and intubation with longer hospital stays compared to those without diabetes with a similar death rate. Old age, HbA1C, comorbidities, diabetic complications, length of hospital stay and ICU admission, and inflammatory parameters were significant predictors of death in diabetic patients.

Predictors and outcomes of discharge to long-term acute care facilities after cardiac surgery

ObjectiveAn increasing number of patients with significant comorbidities present for complex cardiac surgery, with a subgroup requiring discharge to long-term acute care facilities. We aim to examine predictors and mortality after discharge to a long-term acute care facility. MethodsFrom January 1, 2015, to April 30, 2021, all adult cardiac surgeries were queried and patients discharged to long-term acute care facilities were identified. Baseline characteristics, procedures, and in-hospital complications were compared between long-term acute care facility and non–long-term acute care facility discharges. Random forest analysis was conducted to establish predictors of discharge to long-term acute care facilities. Kaplan–Meier survival analysis was used to determine probability of survival over 7 years. Multivariate regression modeling was used to establish predictors of death after long-term acute care facility discharge. ResultsOf 29,884 patients undergoing cardiac surgery, 324 (1.1%) were discharged to a long-term acute care facility. The long-term acute care facility group had higher rates of urgent/emergency operation (54% vs 23%; 10% vs 3%, P < .001) and longer mean cardiopulmonary bypass (167 vs 110 minutes, P < .001). By random forest analysis, emergency/urgent status, longer cardiopulmonary bypass duration, redo surgery, endocarditis, and history of dialysis were the most predictive of discharge to a long-term acute care facility. Although the non–long-term acute care facility group demonstrated greater than 95% survival at 6 months, Kaplan–Meier survival analysis showed 28% 6-month mortality in the long-term acute care facility cohort. Random forest analysis demonstrated that chronic lung disease and postoperative respiratory complications were significant predictors of death at 6 months after discharge to a long-term acute care facility. ConclusionsPatients with chronic lung and kidney disease undergoing prolonged procedures are at higher risk to be discharged to long-term acute care facilities after surgery with worse survival. Efforts to minimize postoperative respiratory complications may reduce mortality after discharge to long-term acute care facilities.

Impact of Lactate Dehydrogenase and Hemoglobin Levels on Clinical Outcomes in Patients With Paroxysmal Nocturnal Hemoglobinuria: Results From the National Korean PNH Registry.

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare hematologic disorder caused by uncontrolled terminal complement activation, which leads to intravascular hemolysis (IVH), thromboembolism (TE), renal failure, and premature mortality. We performed a secondary analysis of data collected from patients enrolled in the Korean National PNH Registry to assess the relative importance of risk factors, specifically lactate dehydrogenase (LDH) and hemoglobin (Hb), in predicting the incidence of TE, impaired renal function, and death in complement inhibitor-naïve patients with PNH. Multivariate regression modeling indicated that LDH ≥ 1.5 × upper limit of normal (ULN), male sex, and pain were associated with increased risk of TE (P = 0.016, 0.045, and 0.033, respectively), hemoglobinuria and pain were associated with an increased risk of impaired renal function (P = 0.034 and 0.022, respectively), and TE was associated with an increased incidence of death (P < 0.001). Hb < 8 g/dL was not a predictor of TE, impaired renal function, or death in multivariate regression analyses. Standardized mortality ratio analysis indicated that LDH ≥ 1.5 × ULN (P < 0.001), Hb < 8 g/dL (P < 0.001), and Hb ≥ 8 g/dL (P = 0.004) were all risk factors for death; in contrast, patients with LDH < 1.5 × ULN had similar mortality to the general population. In complement inhibitor-naïve patients with PNH, LDH ≥ 1.5 × ULN was a significant predictor of TE, and TE was a significant predictor of death. Hb was not a significant predictor of TE, impaired renal function, or death. Therefore, controlling IVH will improve clinical outcomes for patients with PNH.

Prognostic factors in patients with hematological malignancies and concomitant chronic hepatitis C

The study evaluated the impact of HCV infection on the prognosis in patients with hematological malignancies. A total of 96 patients with anti-HCV antibodies were enrolled, with the age of 37.8 (3.0-81.0) years old, 39.6% had non-Hodgkin's lymphoma. Chronic hepatitis C (CHC) was diagnosed in 46.9% patients prior to malignancy development, in 38.5% patients simultaneously with malignancy, and in 14.6% patients during malignancy treatment. Clinical and biochemical signs of HCH were mild in most of the patients, minimal liver fibrosis (F0-1 by METAVIR system) was discovered in 47.3% patients, severe fibrosis or cirrhosis (F3-4) was diagnosed in 40% of participants. Only 20 (20.8%) of patients received antiviral therapy against HCV prior to enrollment. Regression analysis demonstrated that age >55 years old, late onset of antiviral therapy, and poor nutritional status were significant predictors of death from hematological malignancy. Survey conducted among physicians of hematological oncology hospitals in Saint-Petersburg revealed gaps in knowledge on presentation and risks of HCV infection, as well as on opportunities of modern antiviral therapy.

Medical Insurance Coverage and Clinical Outcomes for Patients with Hematological Malignancies in a Rural State

Background Hematological malignancies, such as leukemia, lymphoma, and multiple myeloma, affect blood, bone marrow, and/or the lymphatic system. They can be difficult to treat and often require prolonged and expensive interventions such as chemotherapy, radiation therapy, stem cell transplant, and/or targeted immunotherapy. Due to the complexity and cost of treatment, they pose a significant financial burden on patients and their families. Medical insurance coverage plays a crucial role in providing access to these treatments. This is particularly important for individuals of lower socioeconomic status, and patients in rural states. Aim This retrospective study is focused at examining the relationship between various medical insurance coverage options and/or its absence in influencing the treatment regime and clinical outcomes of patients with hematological malignancies in a statewide cancer registry. Methods This is a retrospective cohort study, conducted by analyzing data in the cancer registry of patients with various hematological malignancies in a single rural state between 2015 and 2022. The patients were divided into study groups based on their insurance providers (Medicare, Medicaid, Private, Military, and Other). Demographic data, cancer treatment data as well as survival data was collected for all patients included in the study. Descriptive statistics were calculated for the overall sample and for each Insurance type subgroup. Due to normality violations, Kruskal Wallis tests (a non-parametric alternative to Analysis of Variance) were utilized to determine if there were statistically significant differences in age, number of treatments, and survival months between the Insurance type groups. To quantify the magnitude of the effect, epsilon-squared (2) was calculated for all between-group comparisons, as a recommended effect size for Kruskal-Wallis tests. Post-hoc group comparisons were conducted when necessary. All categorical variables were evaluated to determine if there were differences present between Insurance type groups using chi-square tests, with post-hoc group comparisons made when necessary. A log-rank test was utilized to compare the survival curves between the Insurance type groups. Univariable and multivariable Cox proportional-hazards regression analysis was used to examine the relationship between survival and Insurance type, when additionally accounting for demographics such as age, race, and sex. All analyses were conducted using R Version 4.3.1 with statistical significance defined as p&amp;lt;0.05. Results The study cohort included 2,472 patients from a single state cancer registry. The study groups differed significantly on age, race, current cancer status, overall treatment summary, chemotherapy, hormone treatment, immunotherapy, hematologic transplant and endocrine treatment, other/palliative treatment, number of treatments, survival length, and overall survival (Table 1). In addition, the survival curves significantly differed by insurance type (Figure 1). Independent predictors of death were age, sex, and insurance type. Multivariable analysis revealed only age and insurance were significant predictors of death with increased risk for older individuals relative to younger and increased risk of death for Medicare, Medicaid, and those that listed their insurance as ‘Other’ relative to those with Private insurance. All assumptions for Cox proportional-hazards regression were tenable. Conclusion There is a strong correlation between insurance types and the outcomes in cancer patients. It revealed that patients with private insurance were more likely to live longer and have more treatment options compared to patients without insurance or other types of coverage. This is reflected in the stratified insurance cohort which showed a 72.8% 5-year survival rate for patients with private insurance, as opposed to Medicare patients who ranked lowest at 49.3%. In addition, the study also highlighted racial disparities in insurance coverage. For instance, evidencing that black &amp; white patients were more likely to be covered in equally by Medicare, while the white patients were over 50% more likely to be covered by other plans as compared to their black counterparts. Overall, the study thoroughly highlights the impact a patient's choice of insurance could portend in ensuring their longevity when battling hematological malignancies

A network study to differentiate suicide attempt risk profiles in male and female patients with major depressive disorder.

Suicide attempts are a possible consequence of Major Depressive Disorder (MDD), although their prevalence varies across different epidemiological studies. Suicide attempt is a significant predictor of death by suicide, highlighting its importance in understanding and preventing tragic outcomes. Researchers are increasingly recognizing the need to study the differences between males and females, as several distinctions emerge in terms of the characteristics, types and motivations of suicide attempts. These differences emphasize the importance of considering gender-specific factors in the study of suicide attempts and developing tailored prevention strategies. We conducted a network analysis to represent and investigate which among multiple neurocognitive, psychosocial, demographic and affective variables may prove to be a reliable predictor for identifying the 'suicide attempt risk' (SAR) in a sample of 81 adults who met DSM-5 criteria for MDD. Network analysis resulted in differences between males and females regarding the variables that were going to interact and predict the SAR; in particular, for males, there is a stronger link toward psychosocial aspects, while for females, the neurocognitive domain is more relevant in its mnestic subcomponents. Network analysis allowed us to describe otherwise less obvious differences in the risk profiles of males and females that attempted to take their own lives. Different neurocognitive and psychosocial variables and different interactions between them predict the probability of suicide attempt unique to male and female patients.

Clinical and Epidemiological Characteristics of Hospitalized COVID-19 Patients in an Isolation Centre in South-West Nigeria.

The clinical presentation of coronavirus disease 2019 (COVID-19) can vary widely, and while the primary infection involves the respiratory system, other organs can also be affected. This study presents the clinical and epidemiological characteristics of hospitalized COVID-19 patients in a tertiary hospital in Ado Ekiti, South-West Nigeria. This is a retrospective study involving COVID-19 patients admitted to the isolation ward between August 2020 and January 2021. The data used for this study was obtained from the patient's medical record, which includes demographic characteristics, clinical presentation, baseline co-morbidities, and laboratory investigations. The average age of the patients was 60.3 years, and more than two-thirds were male. The most common symptoms were fever, shortness of breath, cough, and tiredness. Comorbidities identified among the patients included diabetes mellitus, heart disease, obesity, and chronic kidney disease. The most common radiological findings were bilateral homogeneous patchy opacities and peripheral fluffy infiltrates. The overall mortality rate was 21.9%, with 13 deaths in patients with severe disease. Age and duration of admission were found to be significant predictors of death. The results of this study provide valuable insights into the clinical presentation of COVID-19 in Nigeria and may guide future management strategies for similar infections.

Microscope-assisted coronary artery bypass grafting in diffuse coronary artery disease: immediate and mid-term results

Background: In recent years, a typical candidate for coronary artery bypass grafting (CABG) has become a patient with complex, multivessel coronary artery disease (CAD), often with an unsatisfactory and small distal bed. The prevalence of diffuse CAD is 4.2%-46.0%, and the CABG refusal rate due to this disease accounts for 1.3%-15.0%. Diffuse CAD is an independent predictor of mortality and poor prognosis after CABG. Due to a lack of uniform criteria for diffuse CAD and randomized trials, there is no preferred surgical treatment option for such patients.Objective: To evaluate immediate and mid-term results of microscope-assisted CABG in patients with ischemic heart disease and diffuse CAD.Methods: We calculated a diffuseness score and determined whether the criterion of diffuse lesion by SYNTAX score was met. For our retrospective study we selected 187 ischemic heart disease patients with 3-vessel CAD who underwent microscope-assisted CABG. A coronary lesion with a diffuseness score of &gt;18 was considered diffuse if the SYNTAX score criterion was met for each of the main coronary arteries. The patients were divided into 2 groups: group 1 for patients with diffuse CAD (n = 60) and group 2 for patients with CAD that did not meet the criterion to be considered diffused (n = 127). The propensity score matching was used to reduce differences between the groups. The primary end point was death from any cause; the secondary end points were adverse cardiovascular events (death from cardiac causes, myocardial infarction, repeated revascularization, acute cerebrovascular accident) and angina.Results: No significant differences in the frequency of in-hospital specific and nonspecific complications were found. The frequency of achieved complete revascularization was comparable between the groups. There were no significant differences in the long-term survival, adverse cardiovascular events, and freedom from angina during the median follow-up of 39 months (min 1 month; max 60 months). The univariate analysis after the propensity score matching showed that diffuse CAD was not a significant predictor of death from any cause [hazard ratio (HR), 1.141; 95% CI, 0.348-3.742; P = .83], adverse cardiovascular events [HR, 0.940; 95% CI, 0.425-2.078; P = .88], and angina [HR, 0.817; 95% CI, 0.394-1.696; P = .59]. The multivariate analysis revealed no significant association between diffuse CAD and death from any cause both before [HR, 1.382; 95% CI, 0.396-4.815; P = .61] and after propensity score matching [HR, 2.079; 95% CI, 0.158-27.422; P = .58]. We found that within 60 months after CABG, the risk of death from any cause was increased: by patient’s age [HR, 1.166; 95% CI, 1.043-1.303; P = .007], male sex [HR, 5.583; 95% CI, 1.062-29.344; P = .042], and diabetes mellitus [HR, 3.673; 95% CI, 1.143-11.805; P = .029] before the propensity score matching and by patient’s age [HR, 2.055; 95% CI, 1.028-4.104; P = .041] and cardiopulmonary bypass time [HR, 1.190; 95% CI, 1.014-1.397; P = .033] after the propensity score matching.Conclusion: Microscope-assisted CABG in patients with diffuse CAD can achieve satisfactory immediate and mid-term results. We found no association between diffuse CAD and the risk of adverse events. Received 30 January 2023. Revised 29 June 2023. Accepted 5 July 2023. Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflict of interest. Contribution of the authorsConception and study design: A.N. Semchenko Data collection and analysis: A.M. Shevchenko, I.V. Zaicev, A.V. Semchenko, T.B. VnukovaStatistical analysis: A.N. SemchenkoDrafting the article: A.N. Semchenko, I.V. ZaicevCritical revision of the article: A.M. Shevchenko, A.V. Semchenko, T.B. VnukovaFinal approval of the version to be published: A.N. Semchenko, A.M. Shevchenko, I.V. Zaicev, A.V. Semchenko, T.B. Vnukova

Invasive aspergillosis in adult patients in Australia and New Zealand: 2017–2020

New and emerging risks for invasive aspergillosis (IA) bring the need for contemporary analyses of the epidemiology and outcomes of IA, in order to improve clinical practice. The study was a retrospective, multicenter, cohort design of proven and probable IA in adults from 10 Australasian tertiary centres (January 2017-December 2020). Descriptive analyses were used to report patients' demographics, predisposing factors, mycological characteristics, diagnosis and management. Accelerated failure-time model was employed to determine factor(s) associated with 90-day all-cause mortality (ACM). Of 382 IA episodes, 221 (in 221 patients) fulfilled inclusion criteria - 53 proven and 168 probable IA. Median patient age was 61 years (IQR 51-69). Patients with haematologic malignancies (HM) comprised 49.8% of cases. Fifteen patients (6.8%) had no pre-specified immunosuppression and eleven patients (5.0%) had no documented comorbidity. Only 30% of patients had neutropenia. Of 170 isolates identified, 40 (23.5%) were identified as non-Aspergillus fumigatus species complex. Azole-resistance was present in 3/46 (6.5%) of A.fumigatus sensu stricto isolates. Ninety-day ACM was 30.3%. HM (HR 1.90; 95% CI 1.04-3.46, p=0.036) and ICU admission (HR 4.89; 95% CI 2.93-8.17, p<0.001) but not neutropenia (HR 1.45; 95% CI 0.88-2.39, p=0.135) were associated with mortality. Chronic kidney disease was also a significant predictor of death in the HM subgroup (HR 3.94; 95% CI 1.15-13.44, p=0.028). IA is identified in high number of patients with mild/no immunosuppression in our study. The relatively high proportion of non-A.fumigatus species complex isolates and 6.5% azole-resistance rate amongst A.fumigatus sensu stricto necessitates accurate species identification and susceptibility testing for optimal patient outcomes. This work is unfunded. All authors' financial disclosures are listed in detail at the end of the manuscript.

Predictors of mortality in Ugandan children with TB, 2016-2021.

BACKGROUND: The burden of pediatric TB is high in Uganda. Our objective was to evaluate predictors of mortality during TB treatment among children at an urban and a rural referral hospital.METHODS: We designed a historical cohort study of TB cases at Mulago National Referral Hospital, Kampala; and Fort Portal Regional Referral Hospital, Fort Portal, Uganda, in children aged <15 years from 2016 to 2021. We used Kaplan-Meier models to estimate survival and fit multivariable Cox regression models to determine mortality hazards during TB treatment.RESULTS: We identified 1,658 children diagnosed with TB from 2016 to 2021. Of 1,623 children with known treatment outcomes, 127/1,623 (7.8%) died during TB treatment, 1,298/1,623 (78.3%) completed treatment, 150/1,623 (9.2%) were lost to follow-up, and two children failed treatment. Using Kaplan-Meier functions, the median time to death was 27 days following treatment initiation. In adjusted Cox models, predictors of mortality included HIV (aHR 1.68, 95% CI 1.01-2.81), moderate malnutrition (aHR 2.22, 95% CI 1.18-4.16), and severe malnutrition (aHR 2.92, 95% CI 1.75-4.87).CONCLUSION: Mortality was high at an urban and a rural referral hospital among children who initiated TB treatment from 2016 to 2021, with the majority of deaths occurring during the intensive phase of TB treatment. Malnutrition and HIV were significant predictors of death during treatment.

Characteristics of fatal occupational injuries in migrant workers in South Korea: A machine learning study

ObjectiveAnalysis of occupational injuries is essential for developing preventive strategies. However, few studies have evaluated severe occupational injuries in migrant workers from the perspective of gender. Therefore, using a new analytical method, this study was performed to identify gender-specific characteristics associated with fatal occupational injuries among migrant workers; the interactions between these factors, were also analyzed. In addition, we compared the utility of explainable artificial intelligence (XAI) using SHapley Additive exPlanations (SHAP) with logistic regression (LR) and discuss caveats regarding its use. Materials and methodsWe analyzed national statistics for occupational injuries among migrant workers (n = 67,576) in South Korea between January 1, 2007, and September 30, 2018. We applied an extreme gradient boosting model and developed SHAP and LR models for comparison. ResultsWe found clear gender differences in fatal occupational injuries among migrant workers, with males in the same occupation having a higher risk of death than females. These gender differences suggest the need for gender-specific occupational injury prevention interventions for migrant workers to reduce the mortality rate. Occupation was a significant predictor of death among female migrant workers only, with care jobs having the highest fatality risk. The occupational fatality risk of female workers would not have been identified without the performance of detailed job-specific analyses stratified by gender. The major advantages of SHAP identified in the present study were the automatic identification and analysis of interactions, ability to determine the relative contributions of each feature, and high overall performance. The major caveat when using SHAP is that causality cannot be established. ConclusionDetailed job-specific analyses stratified by gender, and interventions considering the gender of migrant workers, are necessary to reduce occupational fatality rates. The XAI approach should be considered as a complementary analytical method for epidemiological studies, as it overcomes the limitations of traditional statistical analyses.