Strong Predictor Of Mortality Research Articles

Proximal femoral fractures in patients with COVID-19 : Pneumonia and admission from anursing home are the strongest predictors of mortality.

Proximal femoral fractures are severe injuries in geriatric patients. Additionally, geriatric patients are at ahigh risk of death due to coronavirus disease 2019 (COVID-19). To identify predictors of mortality in geriatric patients with COVID-19 and concurrent proximal femoral fractures. Patients who underwent surgical treatment for proximal femoral fractures and also tested positive for COVID-19 were included. The age, gender, the American Society of Anesthesiology (ASA) score and the admission from anursing home were considered as variables. The rate of reoperations, the mortality at 3 months and discharge home were evaluated as outcomes. In this study 46 patients with COVID-19 (female/male 31/15, median age87.0 years with an interquartile range [IQR] of 9.8 years) met the inclusion criteria. Of these, 32patients (69.6%) had to be cared for in the intensive care unit and 26 patients (56.5%) had asevere course of COVID-19 with pneumonia. The median length of hospital stay for survivors was 19 (IQR 17.5) days and 4 of the patients (8.7%) required surgical revision. The in-hospital and 3‑month mortality were 40.0% (n = 17) and 43.5% (n = 20), respectively. The factors which influenced the in-hospital and 3‑month mortality rates were admission from anursing home, the presence of pneumonia (increased the risk of death) and female gender (protective). The occurrence of COVID-19 in patients with proximal femoral fractures has ahigh mortality. Admission from anursing home and the presence of pneumonia increased the risk of death, whereas women were at lower risk.

Disturbance in the potential cardiovascular-bone-skeletal muscle axis and morbidity and mortality in patients undergoing haemodialysis: the Q-Cohort Study.

Disturbances in the cardiovascular system, bone and skeletal muscle are independent risk factors for death among patients receiving haemodialysis (HD). However, the combined impact of disorders of these three organs on morbidity and mortality is unclear in the HD population. A total of 3031 Japanese patients on maintenance HD were prospectively followed. The outcomes were all-cause mortality, major adverse cardiovascular events (MACE) and bone fracture. Patients were divided into four groups (G1-G4) according to the baseline number of diseased organs represented as histories of cardiovascular disease and bone fractures and the presence of low skeletal muscle mass as follows: G1, no organ; G2, one organ; G3, two organs; G4, three organs. Multivariable-adjusted survival models were used to analyse associations between the number of diseased organs and outcomes. During a 4-year follow-up, 499 deaths, 540 MACE and 140 bone fractures occurred. In the Cox proportional hazards model, the risk for all-cause mortality was significantly higher in G2, G3 and G4 than in G1 as the reference {hazard ratio: G2, 2.16 [95% confidence interval (CI) 1.65-2.84], G3, 3.10 [95% CI 2.27-4.23] and G4, 3.11 [95% CI 1.89-5.14]}. Similarly, the risks for developing MACE and bone fractures were significantly elevated as the number of organ disorders increased. Multiple disorders of the cardiovascular-bone-skeletal muscle axis are strong predictors of morbidity and mortality in patients undergoing HD.

Malnutrition as a potential predictor of mortality in chronic kidney disease patients on dialysis: A systematic review and meta-analysis

Background & AimsMalnutrition, a significant problem in patients with chronic kidney disease (CKD), is linked to lower health-related quality of life, longer and more frequent hospital admissions, worse functional capacity, and higher levels of morbidity. However, the extent of its impact on mortality is poorly elucidated. This systematic review and meta-analysis aimed to investigate the impact of malnutrition on mortality among CKD patients on dialysis. MethodsThis meta-analysis was designed and performed in accordance with the PRISMA guidelines (CRD42023394584). A systematic electronic literature search was conducted in PubMed, ScienceDirect, and Embase to identify relevant cohort studies. The studies that reported nutritional status and its impact on mortality in patients were considered for analysis. The generic inverse variance method was used to pool the hazard ratio effect estimates by employing a random effects model. The Newcastle-Ottawa scale was used for the quality assessment. The statistical analysis was performed by utilizing RevMan and CMA 2.0. ResultsA total of 29 studies that comprised 11063 patients on dialysis whose nutritional status was evaluated were eligible for quantitative analysis. Based on a comparison between the "malnutrition" category and the reference "normal nutrition status" category, the results showed that the overall pooled hazard risk (HR) for mortality was (HR 1.49, 95% CI: 1.36–1.64, p<0.0001). According to the subgroup analysis, the hemodialysis subgroup had greater mortality hazards (HR 1.53; 95% CI 1.38–1.70, p<0.0001), compared to the peritoneal dialysis subgroup (HR 1.26; 95% CI 1.15–1.37, p<0.00001). Additionally, the overall incidence of mortality was explored but the authors were unable to combine the results due to limitations with the data. ConclusionThe findings conclude that malnutrition is a strong predictor of mortality among patients on dialysis, with the hemodialysis subgroup having a higher mortality hazard compared to the peritoneal dialysis subgroup. The results of this study will advocate for early nutritional evaluation and timely dietary interventions to halt the progression of CKD and death.

CARDIAC ULTRASOUND ALTERATIONS IN INDIVIDUALS WITH PNEUMONIA RELATED TO COVID-19 INFECTION

A wide range of cardiac effects are observed during the acute phase of COVID-19. Interestingly, troponin levels are raised in 8–28% of instances, while systolic myocardial dysfunction symptoms are not always evident. Subclinical myocardial dysfunction is more common and is commonly defined as a decrease in the left ventricle's global longitudinal strain (LV GLS). Up to 80% of individuals exhibit this alteration while they are in the hospital. LV GLS is a crucial component in risk assessment for follow-up care and a strong independent predictor of in-hospital mortality. The first results on the long-term cardiovascular effects of COVID-19 one year after hospitalization are presented in this study. One year after discharge, we found that patients with COVID-19 pneumonia had a negative trend in LV GLS and deformation metrics in the apical and certain middle segments of the LV myocardium, as compared to data collected three months after discharge. The purpose of the study is to look at the prevalence and clinical significance of long-term heart injury following COVID-19. In order to do this, we examined patient data and categorized patients a year following hospital discharge according to their LV GLS values. This method aids in comprehending the clinical ramifications of long-term cardiac injury after COVID-19.

Self-rated health, epigenetic ageing, and long-term mortality in older Australians.

Self-rated health (SRH) is a subjective indicator of overall health based on a single questionnaire item. Previous evidence found that it is a strong predictor of mortality, although the underlying mechanism is poorly understood. Epigenetic age is an objective, emerging biomarker of health, estimated using DNA methylation data at hundreds of sites across the genome. This study aimed to assess the overlap and interaction between SRH and epigenetic ageing in predicting mortality risk. We used DNA methylation data from 1059 participants in the Melbourne Collaborative Cohort Study (mean age: 69years) to calculate three age-adjusted measures of epigenetic ageing: GrimAge, PhenoAge, and DunedinPACE. SRH was assessed using a five-category questionnaire item ("excellent, very good, good, fair, poor"). Cox models were used to assess the associations of SRH, epigenetic ageing, and their interaction, with all-cause mortality over up to 17years of follow-up (Ndeaths = 345). The association of SRH with mortality per category increase was HR = 1.29; 95%CI: 1.14-1.46. The association was slightly attenuated after adjusting for all three epigenetic ageing measures (HR = 1.25, 95%CI: 1.10-1.41). A strong gradient was observed in the association of GrimAge (Pinteraction = 0.006) and DunedinPACE (Pinteraction = 0.002) with mortality across worsening SRH strata. For example, the association between DunedinPACE and mortality in participants with "excellent" SRH was HR = 1.02, 95%CI: 0.73-1.43 and for "fair/poor" HR = 1.72, 95%CI: 1.35-2.20. SRH and epigenetic ageing were synergistic risk factors of mortality in our study. These findings suggest that consideration of subjective and objective factors may improve general health assessment, which has implications for the ongoing development of molecular markers of ageing.

Rest and stress aortic flow analysis by CMR in MyoFit46

Abstract Background Aortic stiffness is a strong predictor of future cardiovascular events and all-cause mortality. Aortic stiffness has never been measured during adenosine stress perfusion before, and may provide valuable relationship about this relationship. Aim To investigate if there are differences between aortic stiffness and conditions of rest and stress perfusion, in an older age-homogenous population-based cohort. Methods 203 participants from the longitudinal 1946 Medical Research Council National Survey of Health and Development British birth cohort were included. Cardiovascular Magnetic Resonance (CMR) imaging was performed at rest and during adenosine stress perfusion. 3 established and validated biomarkers of aortic stiffness were reported - pulse wave velocity, distensibility and beta stiffness, at rest and stress perfusion. All variables were non-normally distributed, therefore the Wilcoxon signed-rank test was used to look for significant differences between rest and stress. Results Aortic stiffness increased significantly during adenosine stress perfusion, shown by all biomarkers of aortic stiffness used: pulse wave velocity (p = &amp;lt;0.001), distensibility (p = &amp;lt;0.001), and beta stiffness (p = &amp;lt;0.001). However, the aortas of participants with a higher resting aortic stiffness at baseline were less dynamic (little if any aortic stiffness change with stress) when compared to those with low resting aortic stiffness. Conclusion It is feasible to measure aortic stiffness during adenosine stress perfusion. In healthy aortas, aortic stiffness increases in the acute phase of adenosine stress suggesting a new potential mechanism for the body response to adenosine – peripheral chemoreceptor reflex activation. Stiffer arteries at baseline are less modifiable and stress aortic flow CMR has the potential to identify these persons permitting early targeted therapy. Change in aortic stiffness, measured by stress aortic flow CMR is therefore a potential non-invasive biomarker of aortic health.

#2589 Predictive value of serum lactate in ICU dialysis-dependent AKI patients

Abstract Background and Aims Hyperlactatemia is frequently observed in critically ill patients. It is often associated with unfavorable outcomes and serves as a strong predictor of mortality. Renal replacement therapy aims to mitigate lactate accumulation in this particular subgroup of patients, but the effectiveness of this therapy in reducing morbidity and mortality in acute kidney injury (AKI) associated lactic acidosis remains inconclusive. The aim of this retrospective study was to evaluate the predictive role of serum lactate in dialysis-dependent AKI patients stratified on three different underlying etiologies (septic shock, concomitant liver failure and metformin-associated lactic acidosis). Method A retrospective, single-center cohort analysis was conducted to examine patients with AKI who underwent hemodialysis in our ICU between 2022 and 2023 and had a serum lactate &amp;gt; 4 mmol/L. Patients were stratified according to underlying etiology: isolated septic shock with AKI, shock with concomitant AKI and fulminant liver failure (serum ammonia &amp;gt; 100 µmol/L), and AKI with metformin-associated lactic acidosis (MALA). We compared patients according to age and 3-day, 30-day, and 90-day mortality. Finally, we performed receiver-operating-curve (ROC) analysis to potential predictive power of serum lactate for 30-day mortality. Results The median age of our cohort of 63 patients was 67 (range 52 - 74) years, with a median lactate level of 12.9 (7.6 – 18.0) mmol/L. The 3-day, 30-day and 90-day mortality rate was 57%, 78%, and 83%, respectively. We observed that patients with concomitant liver failure were significantly younger (p = 0.004). Interestingly, while all groups have comparable 90-day mortality, patients with septic shock exhibit extremely high 3-day mortality (74%), compared to 35% and 25% for acute liver failure and metformin-associated shock. ROC curve analysis showed that serum lactate was highly predictive of 30-day mortality in group of AKI with concomitant fulminant liver dysfunction. On the contrary, in metformin-associated hyperlactatemia the level of serum lactate showed no such prediction. Conclusion Our retrospective analysis underscores the crucial importance of differentiating between various groups of patients (septic shock, concomitant liver failure and metformin-associated lactic acidosis) in patients with hyperlactatemia. In metformin-induced kidney failure, the level of lactate does not predict mortality, while in the cases of AKI with concurrent acute liver dysfunction our results are highly suggestive that dialysis may not be effective for severe lactacidosis. The findings contribute valuable insights for designing future prospective studies in this complex patient population.

#1555 The effects of different interdialytic intervals on cardiorespiratory fitness assessed with CPET in hemodialysis patients

Abstract Background and Aims Long interdialytic interval in thrice-weekly hemodialysis is associated with excess cardiovascular and all-cause mortality risk. Impaired cardiorespiratory fitness is a strong predictor of mortality in hemodialysis. This study investigated differences in cardiorespiratory fitness assessed with cardiopulmonary exercise testing (CPET) between the end of the 2-day and the 3-day interdialytic interval. Method A total of 28 hemodialysis patients, randomized in two different sequences of evaluation underwent CPET and spirometry examination at the end of the 2-day and the 3-day intervals. The primary outcome was the difference in oxygen uptake at peak exercise [VO2peak (ml/kg/min)] assessed with CPET. Volume status was assessed with interdialytic-weight-gain (IDWG), lung ultrasound, bioimpedance spectroscopy (BIS), and inferior vena cava measurements. A total of 14 age- and sex-matched controls were also evaluated. Results Hemodialysis patients at the end of both 2-day and 3-day intervals presented lower values in all major CPET parameters than controls. VO2peak (ml/kg/min) was significantly higher at the end of the 2-day than the 3-day interval (15.24 ± 4.18 vs 13.64 ± 2.76; p &amp;lt; 0.001); similar were the results for VO2peak (ml/min) (1188 ± 257 vs 1074 ± 224; p &amp;lt; 0.001) and VO2peak (%predicted) (58.9 ± 9.2 vs 52.3 ± 8.6; p &amp;lt; 0.001). Numerical but no statistically significant differences were detected in VO2-anaerobic-threshold(ml/kg/min) and VO2-anaerobic-threshold(ml/min) between the two time-points. Maximal work load (90.1 ± 23.2 vs 79.3 ± 25.1; p &amp;lt; 0.001), exercise duration, HR at peak exercise and oxygen pulse also showed lower values at the end of the 3-day interval. FEV1 levels were similar between the two evaluations. Generalized-linear-mixed-model analysis including IDWG as random covariate attenuated the observed differences in VO2peak (ml/kg/min). Changes in BIS-derived overhydration indexes were moderately correlated with changes of VO2peak (ml/kg/min). Conclusion The 3-day interval was associated with further impairment of VO2 at peak exercise. This effect was predominantly driven by excess fluid accumulation during the extra interdialytic day.

#1458 Adverse muscle composition predicts all-cause mortality in CKD

Abstract Background and Aims Sarcopenia is common in CKD and associates with morbidity and mortality. A rapid and standardized MRI (Magnetic Resonance Imaging) scan protocol allows an accurate muscle composition analysis by quantification of skeletal muscle volume and muscle fat infiltration (MFI). The combined observation of low muscle volume and high muscle fat infiltration, i.e. adverse muscle composition (AMC), is a prevalent muscle composition phenotype within CKD and associates to poor function, high prevalence of comorbidity, and an increased risk for coronary heart disease (CHD). It has also been shown that AMC is an independent predictor of all-cause mortality in patients with non-alcoholic fatty liver disease and in general population. In this study we aimed to investigate muscle composition as predictor of all-cause mortality within participants with CKD in the UK Biobank imaging study (UKB). Method This is a prospective study including UKB participants with CKD defined as having an eGFR cystatin C &amp;lt; 60 ml/min/1, 73 m2. A control group was created by matching each participant with CKD for sex, age, and BMI to four participants with normal eGFR. Cystatin C was analyzed based on blood samples at time of study enrolment 7-9 years prior to the MRI. Fat-tissue free thigh muscle volume and MFI were quantified using a rapid neck-to-knee water and fat separated MRI protocol and automated image analysis (AMRA® Researcher). For each participant, a personalized muscle volume z-score (sex- and body size-specific) was calculated and combined with MFI to divide the participants into four muscle composition phenotype groups; 1) normal muscle composition, 2) only low muscle volume, 3) only high MFI and 4) AMC, using previously published thresholds based on the whole UKB cohort. The thresholds were the 25th percentile (&amp;lt; -0.68 SD) for muscle volume z-score and the 75th percentile (men &amp;gt;7.69%; women &amp;gt;8.82%) for MFI. The mortality data were obtained through the UKB´s linkage to national death registries. All-cause mortality was investigated using Kaplan-Meier curves and Cox regression. Models within participants with CKD were crude and subsequently adjusted for sex, age, BMI, low hand grip strength (&amp;lt;16/27 kg for females/males), physical activity, smoking, alcohol, and previous diagnosis of cancer, prevalent CHD and type 2 diabetes, all assessed at the time of imaging. Results Conclusion AMC, determined by standardized MRI, was a strong predictor of all-cause mortality in CKD. The study results indicate that CKD patients with poor muscle health, identified as having both low muscle volume z-score and high MFI, have a significantly higher mortality risk. This vulnerable group would potentially benefit from targeted interventions and is also of specific interest when evaluating new treatments for CKD.

#655 Warm meal after a haemodialysis session saves the day (and lives?)

Abstract Background and Aims The haemodialysis (HD) process leads to chronic nutrient deficiency, particularly of proteins and amino acids. About 6-12 grams of amino acids loss and 7-8 grams of protein loss occurring during each dialysis session may contribute to hypoalbuminemia, a strong predictor of malnutrition and mortality [1]. Optimal dietary protein intake (DPI) may replenish low plasma amino acids, but DPI inadequacy is a common issue in HD patients, as well as malnutrition due to comorbidities. COVID-19 has made dramatic changes in dialysis centers’ procedures, including the transition from warm meals to cold sandwiches for patients to eat after the session. After the end of COVID-19 pandemic warm meals (meat dish included) were reintroduced. Our aim was to quantify the effect of one to three warm meals per week after the HD session (depending on the regime) on the patients’ protein status. Method Data of 68 patients (24 females and 44 males) on chronic HD were collected after signing the ICF consisting of total protein and albumin values measured two months apart. The first measurement was done while patients were on the long-term sandwich diet after every HD session. The second measurement was done 45 days after the warm meal diet was initiated after every session. Serum total protein and serum albumin were measured, with normal intervals for total serum protein and albumin being 66–81 g/L and 45–51 g/L respectively. The values were compared using Wilcoxon signed-rank test. Results The average albumin value with dry food was 35.9 g/L and for total protein 63.6 g/L, with just 6 patients having normal albumin levels (8.8%) and 21 patients having normal total protein levels (30.9%). The average albumin value after 45 days of HD with warm meals was 39.8 g/L and 66.6 g/L for total protein, with 28 patients having normal albumin levels (41.2%) and 36 patients having normal total protein levels (52.9%). This marks an increase of 4.7% in average value of total protein (3 g/L) and statistically significant increase in albumin value of 10.8% (3.9 g/L, p &amp;lt; 0.001). Greater number of patients had normal total protein and albumin values (4.7 times more patients had a normal albumin level after the initiation of warm meals, and 1.7 times more patients had normal total protein levels). There is a difference regarding male and female patients with a greater impact on males. Male patients had an average total proteins value increase of 5.3% (3.37 g/L) while female patients had 3.5% (2.29 g/L). There was a statistically significant increase in albumin value both for male (p &amp;lt; 0.001) and female patients (p = 0.002). In male patients the average increase was 12% (4.33 g/L), while in female patients it was 8.5% (3.04 g/L). After the introduction of warm meals, 50% of male patients had normal albumin values (vs. 9% before), while 25% of female patients reached normal albumin values (vs. 8.3% before). Conclusion Patients on chronic HD suffer from malnutrition which could lead to significantly higher mortality. Adequate nutrition is crucial for their wellbeing. This study has shown that having a warm meal (protein based) can lead to an increase of total plasma protein and albumin with a higher impact on male patients. In this way we could increase DPI of HD patients, reduce the chance of malnutrition and reduce the cardiovascular risk and mortality.

A simplified pneumonia severity index (PSI) for clinical outcome prediction in COVID-19.

The Pneumonia Score Index (PSI) was developed to estimate the risk of dying within 30 days of presentation for community-acquired pneumonia patients and is a strong predictor of 30-day mortality after COVID-19. However, three of its required 20 variables (skilled nursing home, altered mental status and pleural effusion) are not discreetly available in the electronic medical record (EMR), resulting in manual chart review for these 3 factors. The goal of this study is to compare a simplified 17-factor version (PSI-17) to the original (denoted PSI-20) in terms of prediction of 30-day mortality in COVID-19. In this retrospective cohort study, the hospitalized patients with confirmed SARS-CoV-2 infection between 2/28/20-5/28/20 were identified to compare the predictive performance between PSI-17 and PSI-20. Correlation was assessed between PSI-17 and PSI-20, and logistic regressions were performed for 30-day mortality. The predictive abilities were compared by discrimination, calibration, and overall performance. Based on 1,138 COVID-19 patients, the correlation between PSI-17 and PSI-20 was 0.95. Univariate logistic regression showed that PSI-17 had performance similar to PSI-20, based on AUC, ICI and Brier Score. After adjusting for confounding variables by multivariable logistic regression, PSI-17 and PSI-20 had AUCs (95% CI) of 0.85 (0.83-0.88) and 0.86 (0.84-0.89), respectively, indicating no significant difference in AUC at significance level of 0.05. PSI-17 and PSI-20 are equally effective predictors of 30-day mortality in terms of several performance metrics. PSI-17 can be obtained without the manual chart review, which allows for automated risk calculations within an EMR. PSI-17 can be easily obtained and may be a comparable alternative to PSI-20.

Contrast Volume-to-Estimated Glomerular Filtration Rate Ratio as a Predictor of Short-Term Outcomes Following Transcatheter Aortic Valve Implantation.

Background/Objectives: Contrast-induced acute kidney injury (AKI) is associated with early mortality and adverse events. However, in the setting of transcatheter aortic valve implantation (TAVI), previous literature has failed to establish a correlation between the absolute volume of contrast media administered and mortality. We aimed to investigate the impact of contrast volume administered normalised to estimated glomerular filtration rate (CV/eGFR) on the development of AKI and on 30-day all-cause mortality in TAVI patients. Methods: We retrospectively analysed a cohort of 1150 patients who underwent TAVI at our unit between 2015 and 2018. Results: Follow-up was complete for 1064 patients. There were 23 deaths within the follow-up period and 76 cases of AKI, 9 of which required new renal replacement therapy (RRT). Receiver-operating characteristic (ROC) curve analysis showed fair discrimination for 30-day all-cause mortality at a CV/eGFR ratio of 3.6 (area under the ROC curve (AUC) 0.671). Of patients in whom CV data were available, 86.0% (n = 757) had a CV/eGFR < 3.6 and 14.0% (n = 123) had a CV/eGFR ≥ 3.6. In multivariate logistic regression analysis, CV/eGFR ≥ 3.6 was the strongest predictor of 30-day all-cause mortality (odds ratio 5.06, 95% confidence interval [1.61-15.7], p = 0.004). Other independent predictors were procedural urgency (3.28 [1.04-10.3], p = 0.038) and being under general anaesthesia (4.81 [1.10-17.3], p = 0.023). CV/eGFR ≥ 3.6 was also independently associated with significantly increased odds of AKI (2.28 [1.20-4.17], p = 0.009) alongside significant non-left main stem coronary artery disease (2.56 [1.45-4.66], p = 0.001), and diabetes (1.82 [1.03-3.19], p = 0.037). In supplementary ROC curve analysis, a similar CV/eGFR cut point of 3.6 was found to be an excellent predictor for new RRT (AUC 0.833). Conclusions: In conclusion, a CV/eGFR ≥ 3.6 post-TAVI was found to be a strong predictor of 30-day mortality and AKI. The maximum contrast volume that can be safely administered in each patient without significantly increasing the risk of mortality and AKI can be calculated using this ratio.

Right ventricular to pulmonary artery coupling in patients with different types of aortic stenosis undergoing TAVI.

Right ventricular (RV) dysfunction in patients undergoing transcatheter aortic valve implantation (TAVI) for aortic stenosis (AS) has long been disregarded. We aimed to assess the predictive value of RV to pulmonary artery coupling (RV/PAc), defined as tricuspid annular plane systolic excursion to systolic pulmonary artery pressure, on mortality in different flow types of AS after TAVI. All patients undergoing TAVI for AS at our centre between 2018 and 2020 were assessed; 862 patients were analysed. The cohort was dichotomized using a ROC analysis (cut-off 0.512mm/mmHg), into 429 patients with preserved and 433 patients with reduced RV/PAc. Reduced RV/PAc was associated with male sex and a higher rate of comorbidities. Short-term VARC-3 endpoints and NYHA classes at follow-up were comparable. Reduced RV/PAc was associated with higher 2-year all-cause mortality (35.0% [30.3-39.3%] vs. 15.4% [11.9-18.7%], hazard ratio 2.5 [1.9-3.4], p < 0.001). Cardiovascular mortality was almost tripled. Results were consistent after statistical adjustment and in a multivariate model. Sub-analyses of AS flow types revealed lower RV/PAc in classical and paradoxical low-flow low-gradient AS, with the majority having reduced RV/PAc (74% and 59%). RV/PAc retained its predictive value in these subgroups. RV dysfunction defined by low RV/PAc is a strong mortality predictor after TAVI independent of flow group. It should be incorporated in future TAVI risk assessment.

Impact of clinical frailty scale on short and long term outcome in patients with acute coronary syndrome

Abstract Funding Acknowledgements None. Background As recently outlined in the European Society of Cardiology (ESC) guidelines on acute coronary syndrome (ACS), scarce data still exits about the prognostic role of frailty to guide clinical decision-making for patients with ACS. Purpose To assess the potential predictive value of frailty both for short, and long term all-cause mortality, in a contemporary ACS population. Methods All consecutive admissions due to ACS, from 01/01/2019 to 31/12/2021, were retrospectively reviewed from an internal database of a tertiary cardiac center in Salerno (Italy). Logistic and Cox proportional regression analysis were performed in order to assess the contribution of frailty on 30-days and long term mortality. Frailty was assessed using the Clinical Frailty Scale (CFS) and patients were classified as non frail (CFS 1-4), and frail (CFS 5-9). Both logistic and Cox regression analysis were adjusted for age, gender, GRACE risk score, comorbidity burden, defined by the Charlson comorbidity score (CCS), and all other relevant covariates associated with outcomes of interest in the univariate analysis. In order to estimate the survival rates during the follow-up, a Kaplan Meyer analysis was carried out and differences between the CFS groups were assessed using the log-rank test. Robustness of the results were assessed through an internal validation procedure with bootstrapping. All statistical analyses were performed using SPSS software version 25.0 (SPPS Inc., Chicago, Illinois) and R version 4.0.5 (R Foundation for Statistical Computing, Vienna, Austria). A p-value of less than 0.05 was considered significant. Results 1366 patients were identified. The median age was 68 (58-77). Of these patients, 1087 (79,6%) were classified as non-frail (CFS 1-4), and 279 (20,4%) as frail (CFS 5-9). 120 (8,8%) and 140 (11,2%) deaths occurred, respectively, during the first 30 days from admission, and during long term follow-up (median follow-up time: 15 months; IQR: 10-24). After multivariate regression analysis the CFS was associated with both short and long-term mortality (OR: 1,6, 95% CI: 1,34-1,91; p&amp;lt;0,001 and HR: 1,37, 95% CI: 1,18-1,58; p&amp;lt;0,001, Fig. 1). Patients with CFS ≥ 5 showed significant higher mortality rate during long term follow-up (p&amp;lt;0.001; Fig.2). Conclusions The CFS is a strong predictor of both short and long-term mortality in patients affected by ACS also after comprehensive adjustment for baseline differences in other risk factors.Fig. 2

Clinical Characteristics and the Prognostic Impact of Acute Kidney Injury in Critically Ill Patients with Invasive Pulmonary Aspergillosis in the Intensive Care Unit: A Retrospective, Single-Center Study

Introduction: The incidence and impact of acute kidney injury (AKI) in patients with invasive pulmonary aspergillosis (IPA) admitted to the intensive care unit (ICU) are unknown. Methods: This retrospective study included 140 patients who were diagnosed with IPA and admitted to the medical ICU of China-Japan Friendship Hospital in Beijing, China. AKI was defined according to the Kidney Disease: Improving Global Outcomes guidelines. Data on demographic characteristics, comorbidities, laboratory tests, treatments, and prognosis at ICU admission were collected. Results: The rate of AKI was 71.4% (n = 100), and approximately 30% of the patients had preadmission acute kidney dysfunction. Of the 100 patients with AKI, 19, 8, and 73 patients had stage I, II, and III AKI, respectively, and 64 (87.6%) patients required continuous renal replacement therapy. Overall ICU mortality rate was 52.1%. Irreversible AKI was a strong independent risk factor for ICU mortality (odds ratio 13.36, 95% confidence interval 4.52–39.48, p < 0.001), followed by chronic lung disease, use of intermittent positive-pressure ventilation, and long-term corticosteroid treatment within 1 year prior to ICU admission. Higher cardiac troponin I levels at admission and worse volume control during the first 7 days of ICU stay were potential predictive factors of irreversible kidney dysfunction. Patients with irreversible AKI and those who died during the ICU stay had greater volume overload during the first 14 days of ICU stay. Patients who survived received earlier renal replacement therapy support after ICU admission compared to those who died (median, 2 vs. 5 days; p = 0.026). Conclusion: Compared to the patients with IPA in the absence of AKI, those with AKI presented with more volume overload, worse disease burden, and required stronger respiratory support, while experiencing worse prognosis. Irreversible AKI was a strong predictor of mortality in patients with critical IPA. Better volume control and earlier CRRT initiation should be considered key points in AKI management and prognostic improvement.

Clinical and Laboratory Predictors of Mortality in Pediatric Patients with Severe Dengue at Dhaka Shishu Hospital

Background: Dengue fever, particularly in its severe form, poses a significant health challenge in tropical regions like Bangladesh. Understanding the clinical and laboratory predictors of mortality in pediatric patients with severe dengue is crucial for improving management strategies and patient outcomes. Methods: This cross-sectional analytical study was conducted at the Department of Pediatrics, Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh, from January 2019 to December 2020. It included 300 pediatric patients diagnosed with severe dengue. Results: Of the 300 participants, 286 (95.33%) survived, while 14 (4.67%) succumbed to the disease. Major bleeding, refractory shock, a significant rise in hematocrit, signs of pleural effusion, and ascites were significantly associated with mortality. Hematologically, a low platelet count (&lt;15000/mm3) was a strong predictor of mortality. Elevated serum ferritin levels (&gt;500 micrograms/L) were also significantly associated with increased mortality risk. Conclusions: The study highlights major bleeding, refractory shock, significant hemoconcentration, pleural effusion, ascites, low platelet count, and high serum ferritin levels as key predictors of mortality in pediatric patients with severe dengue. These findings underscore the need for comprehensive clinical monitoring and targeted management strategies to improve outcomes in pediatric dengue patients. J Rang Med Col. March 2024; Vol. 9, No. 1:10-15

THE EFFECTS OF DIFFERENT INTERDIALYTIC INTERVALS ON CARDIORESPIRATORY FITNESS ASSESSED WITH CARDIOPULMONARY EXERCISE TESTING IN HEMODIALYSIS PATIENTS

Objective: Long interdialytic interval in thrice-weekly hemodialysis is associated with excess cardiovascular and all-cause mortality risk. Impaired cardiorespiratory fitness is a strong predictor of mortality in hemodialysis. This study investigated differences in cardiorespiratory fitness assessed with cardiopulmonary exercise testing (CPET) between the end of the 2-day and the 3-day interdialytic interval. Design and method: A total of 28 hemodialysis patients, randomized in two different sequences of evaluation underwent CPET and spirometry examination at the end of the 2-day and the 3-day intervals. The primary outcome was the difference in oxygen uptake at peak exercise [VO2peak(ml/kg/min)] assessed with CPET. Volume status was assessed with interdialytic-weight-gain (IDWG), lung ultrasound, bioimpedance spectroscopy (BIS), and inferior vena cava measurements. A total of 14 age- and sex-matched controls were also evaluated. Results: Hemodialysis patients at the end of both 2-day and 3-day intervals presented lower values in all major CPET parameters than controls. VO2peak(ml/kg/min) was significantly higher at the end of the 2-day than the 3-day interval (15.24±4.18 vs 13.64±2.76;p&lt;0.001); similar were the results for VO2peak(ml/min) (1188±257 vs 1074±224;p&lt;0.001) and VO2peak(%predicted) (58.9±9.2 vs 52.3±8.6;p&lt;0.001). Numerical but no statistically significant differences were detected in VO2-anaerobic-threshold(ml/kg/min) and VO2-anaerobic-threshold(ml/min) between the two time-points. Maximal work load (90.1±23.2 vs 79.3±25.1;p&lt;0.001), exercise duration, HR at peak exercise and oxygen pulse also showed lower values at the end of the 3-day interval. FEV1 levels were similar between the two evaluations. Generalized-linear-mixed-model analysis including IDWG as random covariate attenuated the observed differences in VO2peak(ml/kg/min). Changes in BIS-derived overhydration indexes were moderately correlated with changes of VO2peak(ml/kg/min). Conclusions: The 3-day interval was associated with further impairment of VO2 at peak exercise. This effect was predominantly driven by excess fluid accumulation during the extra interdialytic day.

Regional Distribution of Extracellular Volume Quantified by Cardiac CT in Aortic Stenosis: Insights Into Disease Mechanisms and Impact on Outcomes.

Extracellular volume fraction (ECV) is a marker for myocardial fibrosis and infiltration, can be quantified using cardiac computed tomography (ECVCT), and has prognostic utility in several diseases. This study aims to map out regional differences in ECVCT to obtain greater insights into the pathophysiological mechanisms of ECV expansion and its clinical implications. Three prospective cohorts were included: patients with aortic stenosis (AS) and coexisting AS and transthyretin cardiac amyloidosis were referred for a transcatheter aortic valve replacement and had ECG-gated CT angiography and Technetium-99m-labelled 3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy to differentiate between the 2 cohorts. Controls had CT angiography and cardiac magnetic resonance demonstrating no significant coronary artery disease or infarction. Global and regional ECVCT was analyzed, and its association with mortality was assessed for patients with AS. In 199 patients, controls (n=65; 66% male), AS (n=115), and coexisting AS and transthyretin cardiac amyloidosis (n=19) had a global ECVCT of 26.1 (25.0-27.8%) versus 29.1 (27.5-31.1%) versus 37.4 (32.5-46.6%), respectively; P<0.001. Across cohorts, ECVCT was higher at the base (versus apex), the inferoseptum (versus anterolateral wall), and the subendocardium (versus subepicardium); P<0.05 for all. Among patients with AS, epicardial ECVCT, rather than any other regional value or global ECVCT, was the strongest predictor of mortality at a median of 3.9 (max 6.3) years (adjusted hazard ratio, 1.21 [95% CI, 1.08-1.36]; P=0.002). Regional differences in ECVCT suggest a predilection for fibrosis and amyloid infiltration at the base, subendocardium, inferior wall, and septum more than the anterior and lateral myocardium. ECVCT can predict long-term mortality with the subepicardium demonstrating the strongest discriminatory power. URL: https://www.clinicaltrials.gov; Unique identifiers: NCT03029026 and NCT03094143.

One minute of stair climbing and descending reduces postprandial insulin and glucose with three-minutes improving insulin resistance following a mixed meal in young adults: A Randomized Controlled Trial

Glycemic markers, including postprandial glucose, insulin, and insulin sensitivity, are strong predictors of morbidity and mortality in individuals with and without diabetes. Stair-climbing and -descending (SCD) at a comfortable pace for as little as 1 to 3 minutes after a sugary beverage (300 kilocalories; 100% carbohydrate) improves glucose and insulin, with insulin sensitivity improving with as little as 10 minutes. Objective: To determine if benefits to glucose, insulin, and insulin sensitivity are seen with SCD following consumption of a meal with mixed macronutrients. Hypothesis: SCD will improve to glucose, insulin, and insulin sensitivity in a dose response manner following a mixed meal. Methods: In a randomized, controlled, crossover trial, young adults (N=31) in apparent good health performed SCD for 0, 1, 3, and 10 minutes after a mixed meal (650 kilocalories; 53% carbohydrates, 33% fat, and 14% protein). Differences in glucose, insulin, and insulin sensitivity (ISI) from baseline to 30 minutes were analyzed using a mixed-effects ANOVA. Results: A significant fixed-effect was found for change in glucose [F(2.551,67.17)=4.724, p=.0071)], insulin [F(2.692,74.49)=11.28, p&lt;.0001)], and ISI [F(2.127,56.00)=5.848, p=.0042)]. Compared to control, changes in glucose (mean (95%CI)) were significantly lower after 1 min (-14 (-7 to -21) mg/dL, p=.0006), 3 min (-18 (-9 to -28) mg/dL, p=.0007), and 10 min (-10.0 (-1 to -20) mg/dL, p=.0387); changes in insulin were significantly lower after 1 min (-1.8 (-0.8 to -2.8) μIU/mL, p=.0011), 3 min (-2.8 (-1.7 to -4.0) μIU/mL, p&lt;.0001), and 10 min (-1.1 (-0.1 to -2.0) μIU/mL, p=.0329); and changes in ISI were significantly higher after 3 min (2.4 (1.2 to 3.6), p=.0003) and 10 min (1.3 (0.3 to 2.4), p=.0143) but not 1 min (1.2 (0.0 to 2.5), p=.0587). Conclusion: Postprandial glucose and insulin were improved with as little as 1 minute, and insulin resistance improved with as little as 3 minutes, of SCD at a self-selected, comfortable pace, after consumption of a mixed meal in apparently healthy young adults. None. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Highly comparative time series analysis of oxygen saturation and heart rate to predict respiratory outcomes in extremely preterm infants

Objective. Highly comparative time series analysis (HCTSA) is a novel approach involving massive feature extraction using publicly available code from many disciplines. The Prematurity-Related Ventilatory Control (Pre-Vent) observational multicenter prospective study collected bedside monitor data from >700 extremely preterm infants to identify physiologic features that predict respiratory outcomes. Approach. We calculated a subset of 33 HCTSA features on >7 M 10 min windows of oxygen saturation (SPO2) and heart rate (HR) from the Pre-Vent cohort to quantify predictive performance. This subset included representatives previously identified using unsupervised clustering on >3500 HCTSA algorithms. We hypothesized that the best HCTSA algorithms would compare favorably to optimal PreVent physiologic predictor IH90_DPE (duration per event of intermittent hypoxemia events below 90%). Main Results. The top HCTSA features were from a cluster of algorithms associated with the autocorrelation of SPO2 time series and identified low frequency patterns of desaturation as high risk. These features had comparable performance to and were highly correlated with IH90_DPE but perhaps measure the physiologic status of an infant in a more robust way that warrants further investigation. The top HR HCTSA features were symbolic transformation measures that had previously been identified as strong predictors of neonatal mortality. HR metrics were only important predictors at early days of life which was likely due to the larger proportion of infants whose outcome was death by any cause. A simple HCTSA model using 3 top features outperformed IH90_DPE at day of life 7 (.778 versus .729) but was essentially equivalent at day of life 28 (.849 versus .850). Significance. These results validated the utility of a representative HCTSA approach but also provides additional evidence supporting IH90_DPE as an optimal predictor of respiratory outcomes.