Times Higher Risk Of Death Research Articles

Changing Treatment and Metastatic Disease Patterns in Patients with EGFR Mutated Non-Small Cell Lung Cancer: An ATOMIC Registry Analysis

IntroductionOsimertinib is now a standard 1L therapy for EGFR-mutated advanced non-small cell lung cancer (NSCLC). We aimed to characterize patterns of therapy and longitudinal risk of brain and liver metastasis in a cohort of EGFRm NSCLC. MethodsPatients with metastatic EGFRm NSCLC who received 1L systemic therapy at sites within the Academic Thoracic Medical Investigator’s Consortium (ATOMIC) were included; demographic and clinical data including treatment patterns were described. Analyses of overall survival (OS), time to next treatment (TTNT), and incident brain and liver metastasis were performed on patients who started 1L therapy in ≥2015 using Kaplan-Meier method, Cox regression, and cumulative incidence functions. ResultsThe full cohort included 1,132 patients; mean age 63.4 years, 53% White, 68% female, 67% nonsmoker; 830 patients received 1L systemic therapy in ≥2015. The predominant first EGFR-TKI was erlotinib (65%) prior to 2018 and osimertinib (81%) after 2018. The median TTNT after start of 1L therapy was 13.9 months overall, and longest in patients receiving 1L osimertinib (28 months). In the post 2015 cohort, the baseline prevalence of brain metastasis (BM) was 54% and among patients without baseline brain metastasis, the probability of incident BM at 12, 24, and 48 months was 8%, 22% and 44%, respectively. Development of an on-treatment brain metastasis among patients without baseline brain metastasis was associated with a 3.2 times higher risk of death. ConclusionEven in a contemporary era with prevalent osimertinib use, baseline and longitudinal risk of BM development was high. The ongoing risk of developing BM, together with the associated survival detriment, argues for routine surveillance brain MRIs for patients with EGFRm NSCLC, which are not currently included in guidelines.

Outcomes in Minor Salivary Gland Tumors-A 20+ Year Tertiary-Care Center Experience.

Minor salivary gland carcinomas are challenging to study due to their rarity and heterogeneity. We aim to further characterize clinical characteristics, treatment, and outcomes over 20 years within a single institution. Retrospective chart review was conducted on 210 patients who received primary treatment for minor salivary gland malignancy from 2000 to 2022. Single tertiary-care center. Multivariable Cox proportional hazards method was used to examine the relationship between pre-determined clinically important variables and outcomes. Five-year overall survival was 77.8% (72.0-84.1). Advanced clinical T stage portended over a 2 times higher risk of death and recurrence. High pathologic grade was associated with a near 3 times higher risk of death and recurrence. There was a predominance of occult nodal metastases in level II for oral cavity and oropharynx site tumors. Clinical T stage and grade were important for overall survival, local, regional, and distant recurrence-free survival. Occult nodal metastases occurred most often in level II.

Associations of overactive bladder (OAB) with suicidal ideation incidence and all-cause mortality among the U.S. population

BackgroundFew studies have explored the correlation between overactive bladder (OAB) and suicidal ideation. This study aims to investigate the association between OAB and suicidal ideation, as well as the relationship between OAB and all-cause mortality among individuals with suicidal ideation.MethodsData from the 2005–2018 National Health and Nutrition Examination Survey (NHANES) were analyzed using cross-sectional and cohort study designs. Weighted multivariable logistic regression models were used to examine the association between OAB and suicidal ideation. Kaplan-Meier curves and weighted multivariable Cox proportional hazards models assessed the relationship between OAB and all-cause mortality among those with suicidal ideation. Interaction analyses on subgroups were conducted to validate the findings. Mediation analysis was performed to examine the effect of depression on the relationship between OAB and suicidal ideation.ResultsAmong 33,426 participants aged ≥ 20 years, 1,290 (3.8%) reported suicidal ideation. After adjusting for potential confounders, participants with OAB were 2.57 times more likely to have suicidal ideation (P < 0.001). Over an average follow-up of 87 months, 197 participants with suicidal ideation died. The Cox model revealed that participants with OAB had a 3.08 times higher risk of death (P = 0.006). Kaplan-Meier curves indicated higher survival rates for non-OAB participants. Mediation analysis indicates that depression significantly mediates the relationship between OAB and suicidal ideation, with a mediation proportion of 75.25% (P < 0.001).ConclusionsOAB is positively associated with the incidence of suicidal ideation and all-cause mortality among participants with suicidal ideation. Additionally, the association between OAB and suicidal ideation is mediated by depression.

10 year risk of death in adolescents with learning disability or autism in England: a national cohort study using linked health and education data from ECHILD

BackgroundTransition from adolescent to adult health and education services is a vulnerable period for young people with learning disability (LD) or autism spectrum disorders (ASD), yet there is a lack of information on their risk of death in that period. MethodsWe developed an English national cohort of 11-year-olds enrolled in state schools between 2009/10-20014/15, followed-up until their 22nd birthday, death or 31st August 2020 using linked health, mortality and education data from the ECHILD database. LD and ASD were indicated using diagnoses from hospital admissions or if LD or ASD were a reason for special educational needs provision in education records before age 11. We estimated crude mortality rates and compared with unaffected peers using rate ratios (RR). ResultsThe cohort comprised 3,080,516 young people (52% boys), of whom 4,589 (0.15%) died (crude mortality rate: 0.17/1000 person-years, 95% CI: 0.16-0.17/1000). 45,174 (1.5%) young people were autistic (85% boys; 15% with co-existing LD), of whom 113 died (mortality rate: 0.29/1000 person-years, 95%CI: 0.24-0.35/1000). Mortality was 1.7 times higher for autistic young people compared to their peers (RR: 1.7, 95% CI: 1.4-2.1). Among 40,264 (1.3% of all) young people with LD (63% boys; 17% with co-existing ASD) there were 812 deaths (mortality rate: 2.31/1000, 95%CI: 2.15-2.47/1000PY). They had 17 times higher risk of death (RR: 16.4, 95%CI: 15.2-17.7). ConclusionsYoung people with LD/ASD are more likely to die than their peers. Findings on disparities within these groups according to co-existing comorbidities, sex and socioeconomic factors will be reported.

Ambient air pollution and daily mortality in ten cities of India: a causal modelling study

The evidence for acute effects of air pollution on mortality in India is scarce, despite the extreme concentrations of air pollution observed. This is the first multi-city study in India that examines the association between short-term exposure to PM2·5 and daily mortality using causal methods that highlight the importance of locally generated air pollution. We applied a time-series analysis to ten cities in India between 2008 and 2019. We assessed city-wide daily PM2·5 concentrations using a novel hybrid nationwide spatiotemporal model and estimated city-specific effects of PM2·5 using a generalised additive Poisson regression model. City-specific results were then meta-analysed. We applied an instrumental variable causal approach (including planetary boundary layer height, wind speed, and atmospheric pressure) to evaluate the causal effect of locally generated air pollution on mortality. We obtained an integrated exposure-response curve through a multivariate meta-regression of the city-specific exposure-response curve and calculated the fraction of deaths attributable to air pollution concentrations exceeding the current WHO 24 h ambient PM2·5 guideline of 15 μg/m3. To explore the shape of the exposure-response curve at lower exposures, we further limited the analyses to days with concentrations lower than the current Indian standard (60 μg/m3). We observed that a 10 μg/m3 increase in 2-day moving average of PM2·5 was associated with 1·4% (95% CI 0·7-2·2) higher daily mortality. In our causal instrumental variable analyses representing the effect of locally generated air pollution, we observed a stronger association with daily mortality (3·6% [2·1-5·0]) than our overall estimate. Our integrated exposure-response curve suggested steeper slopes at lower levels of exposure and an attenuation of the slope at high exposure levels. We observed two times higher risk of death per 10 μg/m3 increase when restricting our analyses to observations below the Indian air quality standard (2·7% [1·7-3·6]). Using the integrated exposure-response curve, we observed that 7·2% (4·2%-10·1%) of all daily deaths were attributed to PM2·5 concentrations higher than the WHO guidelines. Short-term PM2·5 exposure was associated with a high risk of death in India, even at concentrations well below the current Indian PM2·5 standard. These associations were stronger for locally generated air pollutants quantified through causal modelling methods than conventional time-series analysis, further supporting a plausible causal link. Swedish Research Council for Sustainable Development.

Factors associated with death in patients admitted with Ebola virus disease to Ebola Treatment Units in Guinea, Sierra Leone, and Liberia – December 2013 to March 2016

Background The 2013-2016 West African Ebola Virus Disease (EVD) outbreak resulted in 28,600 cases and 11,300 deaths officially reported to the World Health Organization. Previous studies investigating factors associated with death had conflicting findings, interventions showing promising outcomes had small sample sizes, studies were often single- or dual-country based and most focused on laboratory-confirmed EVD and not on clinically-suspected EVD. We used the Ebola data platform of the Infectious Disease Data Observatory (IDDO) to review individual patient records to assess factors associated with death, and particularly whether there were differences between laboratory-confirmed and clinically-suspected cases. Methods This was a cohort study involving analysis of secondary data in the IDDO database. The study population included all patients classified as having either clinically-suspected or laboratory-confirmed EVD, admitted to 22 Ebola Treatment Units (ETU) in Guinea, Liberia and Sierra Leone between December 2013 and March 2016. Baseline characteristics and treatments were documented along with ETU exit outcomes. Factors associated with death were investigated by multivariable modified Poisson regression. Results There were 14,163 patients, of whom 6,208 (43.8%) were laboratory-confirmed and 7,955 (56.2%) were clinically-suspected. Outcomes were not recorded in 2,889 (20.4%) patients. Of the 11,274 patients with known outcomes, 4,090 (36.3%) died: 2,956 (43.6%) with laboratory-confirmed EVD and 1,134 (18.8%) with clinically-suspected EVD. The strongest risk factor for death was confirmed disease status. Patients with laboratory-confirmed disease had 2.9 times higher risk of death compared to clinically-suspected patients, after adjusting for other co-variables. Other factors significantly associated with death included a higher risk for patients aged ≥60 years and a lower risk for patients in Sierra Leone. Conclusions Although laboratory-confirmed patients admitted to ETUs fared worse than clinically-suspected patients, the latter still had a substantial risk of death and more attention needs to be paid to this group in future EVD outbreaks.

The prognostic effect of neutrophil-to-lymphocyte ratio and De Ritis ratio in glioblastoma multiforme patients.

Individuals with ahigher De Ritis ratio (aspartate transaminase/alanine transaminase) and neutrophil-to-lymphocyte ratio (NLR) have an inferior survival in varied malignancies. To our knowledge, the prognostic potential of the De Ritis ratio and NLR to predict the survival in nonmetastatic glioblastoma multiforme (GBM) patients remains unclear. In this study, we aimed to explore the prognostic power of the De Ritis ratio and NLR in patients with nonmetastatic glioblastoma multiforme. Data of 262 patients with glioblastoma multiforme have been retrospectively analyzed. Their age, gender, tumor characteristics, AST/ALT ratio, NLR and hemogram values, including age at diagnosis and date of diagnosis were recorded. The median survival time of the study group was 21 months (95% CI: 19‒23 months). The first-year and second-year survival rates were 73.0% and 40.5%, respectively. The univariate analysis revealed that the correlation of survival with age, gender, left/right location of tumor, mean platelet volume and De Ritis ratio did not reach the level of significance. The univariate analysis of the prognostic potential of NLR indicated that a1-unit increase in NLR value translates to a1.05 times higher risk of death (95% CI: 1.01‒1.09). The results of this study lead to the observation that NLR value can serve as an effective prognostic marker in predicting the outcomes of patients with glioblastoma multiforme. It can be positioned as an easily accessible and cost-effective biomarker for establishing appropriate therapeutic strategies (Tab. 2, Fig. 1, Ref. 20).

#364 Patient characteristics, treatment history and prognosis of adult survivors of childhood kidney replacement therapy—an ERA Registry study

Abstract Background and Aims Young adults who initiated kidney replacement therapy (KRT) during childhood and reached their 18th birthday (i.e. adult survivors of childhood KRT) are a particularly challenging patient group. Besides the changes associated with adolescence, they go through a transition from paediatric to adult nephrology centres, in which patients are expected to take responsibility of their own care. This increases the risk of non-compliance to treatment and graft failure. Nevertheless, not many epidemiological studies have focused on adult survivors of childhood KRT. This type of study would support healthcare providers in obtaining knowledge about the prognosis of this patient group and, perhaps, recognizing possibilities of treatment improvements. We aimed to provide up-to-date information on patient characteristics, treatment history, (graft) survival, 5-year prognosis and expected remaining lifetime of adult survivors of childhood KRT. Method KRT data was used from 21 European countries/regions that contributed with individual patient data to the European Renal Association (ERA) Registry. Adult survivors of childhood KRT, reaching the age of 18 years between 2008 and 2019, were included in the analysis, and their patient characteristics and treatment trajectories were examined. Kaplan-Meier and Cox proportional hazards regression were used in patient and graft survival analyses. The expected remaining lifetime of all KRT patients from the age of 18 years onwards was calculated overall and stratified by sex and treatment modality at the 18th birthday. Results We included 2 944 patients in the analysis, most of them were 10-14 (32.9%) or 15-17 (30.6%) years at start of KRT, and congenital anomalies of the kidney and urinary tract (CAKUT) were the most frequent cause of kidney failure (38.8%). Peritoneal dialysis was the most common treatment at start of KRT (37.8%), yet the percentage of adult survivors who received a pre-emptive kidney transplant increased from 25.6% in 2008-2011 to 32.4% in 2016-2019. By their 18th birthday, 81.4% of patients had a functioning kidney transplant. The overall unadjusted 5-year patient survival after their 18th birthday was 96.9% (95% CI 96.2-97.5), yet adult survivors on dialysis had an almost 4 times higher risk of death than their peers with a functioning kidney graft (adjusted HR 3.76 (95% CI: 2.55-5.53)). Besides, about 21% of the grafts failed during the 5 years after the 18th birthday (unadjusted 5-year graft survival: 78.9% (95% CI: 77.1-80.7)). Eighteen-year-old kidney transplant recipients reached 74% of the expected remaining lifetime of the general population, whereas dialysis patients only reached 37%. Conclusion Even at the young age of 18 years the remaining life expectancy of kidney transplant recipients was lower compared with the general population, and about one fifth of the grafts failed within 5 years after the patients’ 18th birthday. Still, as expected, adult survivors with a functioning kidney transplant at 18 years showed better outcomes than the ones on dialysis, with a greater 5-year survival and longer life expectancy. This epidemiological study reports on one of the biggest cohorts of adult survivors of childhood KRT studied to date. It provides unique knowledge on the prognosis of these patients, establishing the first step towards the optimization of care in this challenging patient group.

Survival analysis of PLWHA undergoing combined antiretroviral therapy: exploring long-term prognosis and influencing factors.

The survival time of human immunodeficiency virus (HIV)-infected individuals or patients with acquired immunodeficiency syndrome (AIDS) is influenced by multiple factors. Studying survival and influential factors after antiretroviral therapy (ART) contributes to improving treatment protocols, management strategies, and prognosis for people living with HIV/AIDS (PLWHA). This retrospective cohort study collected case data and follow-up records of PLWHA who received ART in Dazu District, Chongqing City, between 2007 and 2022. Cumulative survival rates were calculated using life tables. Survival curves were plotted using the Kaplan-Meier method. Uni-variable and multivariable Cox proportional hazards models analyzed factors influencing survival. The study included 5,237 PLWHA receiving ART. Within the first year of ART initiation, 146 AIDS-related deaths occurred, accounting for 29.49% (146/495) of total deaths. Cumulative survival rates at 1, 5, 10, and 15 years were 0.97, 0.90, 0.85, and 0.79, respectively. During the observation period, male patients who received ART had a 1.89 times higher risk of death compared to females (aHR, 1.89; 95%; CI, 1.50-2.37). Patients aged ≥60 years had a 3.44-fold higher risk of death than those aged <30 years (aHR, 3.44; 95% CI, 1.22-9.67). Injection drug users (aHR, 4.95; 95% CI, 2.00-12.24) had a higher risk of death than those with heterosexual (aHR, 1.60; 95% CI, 0.69-3.72) and homosexual transmission. Patients with a baseline CD4+ T lymphocyte count <200 cells/μL (aHR, 8.02; 95% CI, 4.74-13.57) and between 200 and 349 cells/μL (aHR, 2.14; 95% CI, 1.26-3.64) had a higher risk of death than those with ≥350 cells/μL. Patients with ART initiation at WHO clinical stage IV had a 2.48-fold higher risk of death than those at stage I (aHR, 2.48; 95% CI, 1.17-5.23). The first year following ART initiation is critical in HIV/AIDS treatment, emphasizing the need for intensified follow-up and monitoring to facilitate successful immune system reconstruction. Older age, male sex, injection drug use, baseline CD4+ T lymphocyte count <200 cells/μL, and WHO clinical stage IV are associated with an increased risk of death. Tailored treatment and management strategies should be implemented for patient populations at higher risk of mortality and with a poorer prognosis.

DISP-14. THE ASSOCIATION BETWEEN MEDICAID ENROLLMENT CONTINUITY AND CHILDHOOD, ADOLESCENT, AND YOUNG ADULT BRAIN TUMOR SURVIVAL

Abstract BACKGROUND Disparities in younger cancer patient survival between individuals with Medicaid and private insurance have been reported. To further understand this association for brain tumor survival, we used Surveillance, Epidemiology, and End RESULTS (SEER)-Medicaid-linked data to test two hypotheses: 1) those enrolled in Medicaid have lower brain tumor survival than those not enrolled, and 2) those with discontinuous enrollment in Medicaid around the time of diagnosis have lower survival than those with continuous enrollment. METHODS SEER-Medicaid linked data on individuals diagnosed with a first malignant primary brain cancer between 0 to 39 years from 2006 to 2013 were obtained with follow-up through 2018. Medicaid enrollment was classified as continuous (enrolled six months before through six months after diagnosis) and discontinuous (enrolled non-continuously in the twelve months surrounding the diagnosis month). We used Kaplan-Meier (KM) curves and Cox Proportional Hazards (PH) regression models with SEs clustered on state to evaluate survival differences in association with Medicaid enrollment timing after adjusting for age, race/ethnicity, and a measure of census tract poverty. RESULTS Our analytic dataset included 10,110 children, adolescents, and young adults, including 3,148 brain tumor deaths. Consistently lower survival probabilities over time were observed for those enrolled in Medicaid, particularly those with discontinuous enrollment for both age groups. Higher hazards of death were observed for those enrolled in Medicaid vs. not enrolled (HR0-19 =1.66 95% CI 1.41-1.95; HR20-39=1.38, 95% CI 1.27-1.51) and with discontinuous vs. continuous in Medicaid enrollment (HR0-19 =1.60, 95% CI 1.43-1.81; HR20-39=2.03, 95% CI 1.75-2.36). CONCLUSIONS These results indicate Medicaid enrollment continuity has an impact on the risk of death, with discontinuous enrollment associated with an over two times higher risk of death for young brain tumor patients. These results further support the critical need for consistent health insurance coverage for children, adolescents, and young adults.

Progression of Disease within 2 Years Predicts Poor Survival in Patients with Classic Hodgkin Lymphoma

Background: Early progression within 24 months (POD24) of initial immunochemotherapy was repeatedly confirmed to be associated with poor survival in follicular, diffuse large B-cell and mantle-cell lymphomas, identifying its high-risk subgroup with different disease biology (Casulo C, JCO 2015; Maurer JM, JCO 2015; Bond DA, Blood Adv 2021). Little is known about the POD24 incidence and clinical impact in Hodgkin lymphoma (HL) patients, and current prognostic schemes have been designed with longer survival endpoints (Rodday AM, JCO 2022). Methods: This single-center study comprised patients (pts) with classic HL (cHL) treated with frontline chemotherapy prospectively enrolled in the Czech Hodgkin Lymphoma Study Group database in 1993-2020 (database lock was done on 15. June 2023). Early event was defined as progression, relapse, or death related to progressive HL within 24 months after the date of diagnosis. Overall (OS) and progression-free survival (PFS) were calculated from the date of diagnosis. To evaluate the association between early POD and OS from a risk-defining event, that is, survival from the time of POD for early progressors (POD24 group) or from 2 years after diagnosis for the reference group (noPOD24 group), was calculated. In total, we have identified 417 pts with cHL diagnosed from 1993 to the end of 2020. Ten pts have been excluded from the analysis because of early death (&amp;lt;24 months) with no recorded disease progression. Results: The analyzed cohort consisted of 407 pts: 205 females and 202 males with a median age of 35 years (min 16, max 78) with limited disease (stage I-II) in 58% and advanced disease (stage III-IV) in 42%. Histological subtypes were as follows: nodular sclerosis in 53.1%, mixed cellularity in 35.6%, lymphocyte-rich in 3.7%, and lymphocyte-depleted in 0.3%. Subtype was not available in 7.3% of the pts. Extranodal disease and B symptoms were present in 25% and 49%, respectively. 42% of patients had high-risk IPS of 3 or more points. Patients received BEACOPP in 55.5%, Stanford V in 23%, ABVD in 12%, and COPP in 7%. Other treatments were used in 2,5% of the cases. The complete and partial remission rates after frontline treatment were 88.7% and 8.6%, respectively, and only 3% of the pts did not respond to therapy. After a median follow-up of 12.1 years, a cumulative incidence of progression/relapse is 0.14 (95%CI 0,10-0.18). The POD24-event occurred in 36 pts (8.8%) and 38 (9.3%) patients relapsed after 2 years. The entire group's 5-y PFS and 5-y OS reached 81.0% (95% CI 0.77-0.85) and 91.4% (95% CI 88.6-0.94), respectively. The 5-y OS since the risk-defining event was 48.1% (95% CI 31.4-64.8) and 94.2% (95% CI 0.92-96.7) in the POD24 vs noPOD24 group (p&amp;lt;0.001, HR=5.35), Fig 1. When comparing 12 baseline clinical and laboratory characteristics between POD24 (n=35) with noPOD24 controls (n=371), we have found no major differences (Tab 1). There was a trend in more frequent POD24 in the patients with massive mediastinal tumor (p=0.07) and those with advanced clinical stage (p=0.047). The spectrum of the induction regimes was distributed equally (p=0.26). Conclusions: Early progression of the disease is rare; however, a catastrophic event in HL resulting in more than five times higher risk of death. Baseline disease characteristics - besides the clinical stage - do not predict the risk of later POD24 events. Large independent validation may enhance the validity of these data and help create a prognostic tool for POD24 prediction. This event should be considered an important endpoint in Hodgkin lymphoma clinical trials in the future. Acknowledgements: Supported by MH CZ - DRO (FNOL, 00098892), IGA_LF_2023_005 and AZV NU22-03-00182.

Mortality from COVID-19 in Amazonian and Andean original indigenous populations of Peru

ObjectiveTo compare the mortality rates from COVID-19 among indigenous populations of the Amazon and Andean regions of Peru during the years 2020, 2021 and 2022. MethodsSecondary analysis of 33,567 data from the COVID-19 Notification System of the National Epidemiology Center, Prevention and Control of Diseases (CDC-Peru), from the years 2020–2022. The variables were age, sex, belonging to the Andean or Amazonian ethnic group, number and type of symptoms and risk conditions, abnormal findings in chest X-rays, year of data collection for hospitalization and death from COVID-19. Poisson family generalized linear regression models with logarithmic linkage and robust variance were used to establish differences in mortality between ethnic groups. Crude and adjusted risk ratio (RR) with 95 % confidence intervals (CI) were calculated. Results33,567 participants with an average age of 33.6 years were included, 44.4 % were men and 70.2 % belonged to the Amazonian ethnic group. Most of those affected by COVID-19 presented 2 symptoms (38.8 %), 4.8 % presented some risk condition, 1451 (4.3 %) were hospitalized, and 433 (1.3 %) died. The adjusted analysis showed that the Andean group, compared to the Amazonian, tended to have a higher probability of death, and this association was statistically significant, RR =7.6, 95 % CI (5.5–10.5). ConclusionsPatients from Andean indigenous communities had an almost 8 times higher risk of death from COVID-19.

Risk factors for mortality in infancy and childhood in children with major congenital anomalies: A European population-based cohort study.

Preterm birth and young maternal age are known risk factors for infant and childhood mortality. There is limited knowledge of the impact of these risk factors in children born with major congenital anomalies (CAs), who have inherently higher risks of death compared with other children. To investigate the risk factors for mortality up to age 10 years in children born with specific major CAs. This population-based cohort study involved 150,198 livebirths from 1995 to 2014 in 13 European CA registries linked to mortality data. Cox proportional hazards models estimated the association of gestational age, maternal age and child's sex with death <1 year and 1-9 years for the whole cohort and by CA subgroup. Hazard ratios (HR) from each registry were pooled using multivariate meta-analysis. Preterm birth had a dose-response association with mortality; compared with infants born at 37+ weeks gestation, those born at <28, 28-31 and 32-36 weeks had 14.88 (95% CI 12.57, 17.62), 8.39 (95% CI 7.16, 9.85) and 3.88 (95% CI 3.40, 4.43) times higher risk of death <1 year, respectively. The corresponding risks at 1-9 years were 4.99 (95% CI 2.94, 8.48), 3.09 (95% CI 2.28, 4.18) and 2.04 (95% CI 1.69, 2.46) times higher, respectively. Maternal age <20 years (versus 20-34 years) was a risk factor for death <1 year (HR 1.30, 95% CI 1.09, 1.54) and 1-9 years (HR 1.58, 95% CI 1.19, 2.10). Females had 1.22 (95% CI 1.07, 1.39) times higher risk of death between 1 and 9 years than males. Preterm birth was associated with considerably higher infant and childhood mortality in children with CAs, comparable to estimates reported elsewhere for the background population. Additional risk factors included young maternal age and female sex. Information on risk factors could benefit clinical care and guide counselling of parents following CA diagnoses.

Comparison of Sputum Evaluation Conversion of Pulmonary TB patients with DM and non-DM in High Burden Setting

ABSTRACT&#x0D; Background&#x0D; Tuberculosis (TB) remains a global health problem and is one of the leading causes of death worldwide. By 2022, an estimated 10 million people will suffer from TB worldwide. Based on data from the Global Tuberculosis Report in 2022, Indonesia ranks second as a high-burden country in the world after India. An estimated 1.5 million people die from tuberculosis, becoming the 13th leading cause of death worldwide and the second most deadly infectious disease after COVID-19.&#x0D; Currently, many new cases of TB are influenced by several risk factors, one of which is Diabetes Mellitus (DM). Pulmonary TB is a potential opportunistic infection for people with Diabetes Mellitus. TB patients with DM are at risk of sputum conversion failure after TB treatment, 1.69 times higher risk of treatment failure, 1.24 times higher risk of anti-TB drug resistance, 3.89 times higher risk of relapse, and 4.95 times higher risk of death during treatment compared to TB patients.&#x0D; Aim of Study&#x0D; To evaluate the sputum smear conversion results at the end of the second month of treatment of patients with Tuberculosis with Diabetes Mellitus (TB-DM) and Tuberculosis Non-Diabetes Mellitus (TB-NDM).&#x0D; Methods&#x0D; This research was analytical with a retrospective cohort design by taking secondary data from the Tuberculosis Information System (SITB). The data were recorded in SITB and registered as TB patients undergoing Anti-Tuberculosis Drug treatment and screening for Diabetes Mellitus in all districts in West Nusa Tenggara Province in 2022.&#x0D; Results&#x0D; Among 200 patients with TB in this study, male patients dominated 62% of TB patients. TB patients are mostly found in the age group 46-55 years with 28,5%. Generally, TB patients come from Mataram, with an 18% percentage. Most TB patients were diagnosed using GeneXpert (80,5%). The sputum conversion rate at the end intensive phase in TB-DM patients reached 95%, while in TB-NDM patients, only 85%. The comparative test showed a significant difference between the AFB Sputum Evaluation conversion results between TB patients and those without DM (p-value: 0.018, p&lt;0.05).&#x0D; Conclusion &#x0D; There is a significant difference between the AFB Sputum Evaluation conversion results between TB patients and those without DM.&#x0D; &#x0D; Keywords : Diabetes, diabetes mellitus, sputum conversion, tuberculosis, TB, DM

Dementia increases the risk of death in stroke patients: A retrospective cohort-based risk score model study

BackgroundThe relationship between dementia and the mortality of stroke is a significant concern for patients and careers. However, there are few research about it in China and a lack of reliable data on the risk of dementia. We aim to analyze and compare the risk of death in stroke patients with and without dementia. Further investigation into the predictive value of dementia for stroke death. MethodsAll patients with stroke who were identified among residents of Ningxia, between January 1, 2014 to December 31, 2021, set death or May 22, 2022 as the observation endpoint. All patients were screened by 1:4 propensity score matching (PSM). The association between dementia and all-cause mortality was evaluated using Cox regression with survival time. Evaluation of the predictive value of dementia using decision curve analysis (DCA) and clinical impact curve (CIC) curves. ResultMortality of stroke with dementia is 45.4% and without dementia is 13.8%, further calculated one-year mortality is higher in the patients with dementia than without dementia (17.3%vs. 5.4%, p < 0.001). Stroke patients with dementia had a 3.74 times higher risk of death (95% CI = 3.29,4.26) and had a shorter survival time than those without dementia. Dementia was an independent predictor of death in all models (hazard ratio [HR]=3.77,95%CI: 3.31-4.30, p < 0.001). DCA and CIC curves indicated that dementia has a high value in predicting the risk of death in stroke patients. ConclusionDementia is an independent risk factor for death and reduces survival time in stroke patients.

Clinical outcomes by supplemental oxygen use in remdesivir-treated, hospitalised adults with COVID-19

BackgroundClinical trials show different effects of remdesivir on clinical outcomes relative to COVID-19 severity at hospital admission; in Europe, there are few real-world data. MethodsA multicentre, multinational retrospective cohort study in adult patients hospitalised with PCR-confirmed COVID-19 was conducted to understand remdesivir clinical use in different countries and to describe outcomes for patients receiving remdesivir stratified by oxygen use. Primary endpoints were all-cause mortality at day 28 and hospitalisation duration. Patients were categorised by baseline disease severity: no supplemental oxygen (NSO); low flow oxygen ≤ 6 litres (l)/minute (LFO); high flow oxygen > 6 l/minute (HFO). ResultsFour hundred and forty-eight (448) patients (72 [16.1%] HFO; 295 [65.8%] LFO; 81 (18.1%] NSO) were included; median age was 65 years and 64% were male. Mortality was higher in patients on HFO (rate 23.6%) compared to LFO (10.2%; p = 0.001) or NSO (6.2%; p = 0.002). Duration of hospitalisation was longer in patients on HFO (13 days) compared to LFO (9 days; p = 0.003) and NSO (9 days; p = 0.021). Patients who initiated remdesivir ≥ 2 days compared to within a day of hospitalisation had a 4.2 times higher risk of death, irrespective of age, sex, comorbidities, and oxygen support at baseline. Requirement for mechanical ventilation/ECMO and readmission within 28 days of discharge was similar across groups. Remdesivir use and outcomes differed by country. ConclusionsA higher mortality rate and duration of hospitalisation was seen in remdesivir-treated COVID-19 patients on HFO compared to LFO and NSO. Initiation of remdesivir upon admission as opposed to delayed initiation has a mortality benefit.Clinical Trials Registration: NCT04847622.

#5044 FLUID BALANCE AND GLOMERULAR FILTRATION RATE AS PREDICTORS OF OUTCOME AMONG COVID-19 PATIENTS IN THE ICU

Abstract Background and Aims Acute kidney injury (AKI) is associated with an increased risk of progression to a severe form in every disease and, moreover, is associated with an increased mortality, and so it is also with coronavirus disease 2019 (COVID-19). AKI is a frequent complication in COVID-19 patients admitted to ICU for severe respiratory failure. ICU treatment itself indirectly could cause or exacerbate renal damage, through suboptimal fluid management, drug toxicity, or low human resources. The aims of this study were to assess AKI prevalence, fluid balance and glomerular filtration rate as a predictor of outcome in COVID-19 patients treated in the intensive care unit. Method We retrospectively analysed all adult patients admitted to the ICU at a regional hospital in northern Bavaria, from 1st March to 31st December 2020. Clinical data and laboratory results were retrospectively retrieved from the hospital information system and electronic case files. According to the severity of AKI based on the KDIGO criteria, and laboratory values were followed on the first 7 days on the ICU. In total 320 patients patients were included in the study. Level of significance was set to p&amp;lt;0.05. Results The mean age was 65 ± 19 years, 135 (42%) patients were females, 185 (58%) were males. Median length of ICU stay was 7 (2-13 days) in females, and 8 days (4- to 21 days) in males. At the ICU, 177 patients needed some form of ventilation, from which 109 (needed Invasive mechanical ventilation). During ICU stay, 81 patients have died, with fatality rate of 25%. Patients with AKI (n=48, 15%) at the admission to the ICU, had 2.1 times higher risk of death at the ICU than patients without AKI. There was a statistically significant difference in ICU survival based on a glomerular filtration rate, fluid balance, CRP and leukocyte values, F=1.957, p=0.026; Wilk's Λ=0.724, partial η2 = 0.276 Conclusion Acute kidney injury is common in coronavirus disease 2019, and it is associated with poor clinical outcomes. Even first couple of days at the ICU could point to the outcome, with markers of inflammation, glomerular filtration rate, and fluid balance being most valuable variables.

Characteristics of neonates with low birth weight under 1500 g at the Pediatric Center, Hue Central Hospital

Background: Very low birth weight neonates account for only 4 - 7% of all live births but require a great deal of time, care, and medical resources. Very low birth weight babies are mostly under 32 weeks and premature babies less than 1500 g have a 247.6 times higher risk of death than babies weighing more than 3000 g. Objective: To describe the characteristics and identify some risk factors involved in the mortality of neonates weighing less than 1500 g. Materials and methods: Longitudinal follow-up study on 184 neonates at the Department of Neonatology, Pediatrics Center - Hue Central Hospital from May 2019 to June 2021. Results: The median weight of the study group was 1000 (809 – 1200)g, the median gestational age was 28 (26 - 30) weeks, the male/female ratio was 1.5:1. Neonatal sepsis was the most common disease accounting for 88.0%, and septic shock accounted for 13.0%; acute respiratory distress syndrome accounted for 77.7%; the rate of pulmonary hemorrhage and pneumothorax was 22.8% and 8.7%, respectively; intraventricular hemorrhage accounted for 10.7% and severe asphyxia accounted for 13.6%; 71.7% of neonates had indirect hyperbilirubinemia and 71.2% of neonates had anemia; the rates of hypothermia, hypoglycemia, and hyperglycemia were 47.8%; 25.5% and 16.3%, respectively. The neonatal mortality rate was 41.8% and early neonatal mortality accounted for 3/4 of neonatal mortality. The final multivariable logistic regression model indicated that the risk factors for death were: less than 2 doses of antenatal dexamethasone (OR = 2.5; 95%CI: 1.0 - 6.0; p &lt; 0.05), birth weight &lt; 1000 g (OR = 3.5; 95%CI: 1.4 - 8.5; p &lt; 0.05), gestational age &lt; 28 weeks (OR = 4.2; 95%CI: 1.5 - 11.8; p &lt; 0.05), pulmonary hemorrhage (OR = 5.3; 95%CI: 1.9 - 14.9; p &lt; 0.05), severe asphyxia (OR = 4.7; 95%CI: 1.2 - 18.0; p &lt; 0.05) and septic shock (OR = 6.2; 95%CI: 1.9 - 20.3; p &lt; 0.05). Key words: very low birth weight, pathological characteristics, mortality risk

The long-term psycho-social impact of the pandemic on people with intellectual disability and their carers.

People with intellectual disabilities (PWID) are at six times higher risk of death due to COVID-19. To mitigate harm, as a high-risk group, significant social changes were imposed on PWID in the UK. Alongside these changes, the uncertainty of the pandemic influence, caused PWID and their carers to encounter significant stress. The evidence of the pandemic's psycho-social impact on PWID originates mainly from cross-sectional surveys conducted with professionals and carers. There is little research on the longitudinal psycho-social impact of the pandemic from PWID themselves. To examine the long-term psycho-social impact of the pandemic on PWID. A cross-sectional survey, following STROBE guidance, of 17 Likert scale statements (12 to PWID and 5 to their carers) to ascertain the pandemic's psychosocial impact was conducted. Every other PWID open to a specialist Intellectual Disability service serving half a UK County (pop:500,000) was selected. The same survey was re-run with the same cohort a year later. Descriptive statistics, Mann-Whitney, Chi-square and unpaired-t tests were used to compare responses. Significance is taken at p < .05. Comments were analysed using Clarke and Braun's approach. Of 250 PWID contacted, 100 (40%) responded in 2020 and 127 (51%) in 2021. 69% (2020) and 58% (2021) reported seeking medical support. Carers, (88%, 2020 and 90%, 2021) noticed emotional changes in PWID they cared for. 13% (2020) and 20% (2021) of PWID had their regular psychotropics increased. 21% (2020) and 24% (2021) had their pro re nata (PRN) medication adjusted. PWID or carers demonstrated no statistically significant variation in responses between themselves from 2020 to 2021. PWID were more likely to report being upset/distressed compared to their carers' perceptions of them in both years (p < .001). Four themes were identified. This longitudinal study highlights the diverse psycho-social impact of the pandemic on PWID in the UK. The Pandemic's psycho-social impact has been significantly underestimated.

Gilteritinib (XOSPATA®) in Turkey: Early Access Program Results.

Gilteritinib (XOSPATA®, Astellas) is a type I oral FLT3 inhibitor, a tyrosine kinase AXL inhibitor, involved in both c-Kit and FMS-like tyrosine kinase 3 (FLT3) resistance. In the phase 3 ADMIRAL trial, gilteritinib was compared with the standard of care in (R/R) acute myeloid leukemia (AML) patients who harbored any FLT3 mutation and showed superior efficacy with regard to response and survival. This research aimed to investigate the real-life efficacy and safety of gilteritinib in FLT3-positive R/R AML patients who were treated as a part of an early access program held in Turkey in April 2020 (NCT03409081). The research included 17 R/R AML patients who had received gilteritinib from seven centers. The overall response rate was 100%. The most common adverse events were anemia and hypokalemia (7 patients, 41.2%). Grade 4 thrombocytopenia was observed in one patient only (5.9%), leading to permanent treatment discontinuation. Patients with peripheral edema had a 10.47 (95% CI: 1.64-66.82) times higher risk of death than those without peripheral edema (p<0.05). This research showed that patients with febrile neutropenia and peripheral edema were at a high risk of death when compared to patients without febrile neutropenia and peripheral edema.