Times Higher Risk Of Mortality Research Articles

Clinical and viral profile of children admitted in the paediatric intensive care unit due to severe acute respiratory infection during seasonal surge from a tertiary care centre in Eastern India

Background: Acute lower respiratory infections (ALRI), such as pneumonia and bronchiolitis are a leading cause of morbidity and mortality in young children worldwide. Aetiology in young children is mostly viral infection or viral and bacterial infection. Objectives: To study various clinical characteristics among different age groups and viral profiling in children requiring intensive care due to ALRI. Method: Children between 1 month to 12 years, who satisfied the case definition of severe acute respiratory infection (SARI) and who were shifted to the paediatric intensive care unit (PICU) for ventilatory support were included in the study. All children were subjected to history taking, detailed examination, required blood investigations, oropharyngeal and nasopharyngeal swab testing. Results: Of the total 46 cases 32 (69.5%) were <1 year of age, 11 (24%) 1 to 5 years of age, and 3 (6.5%) above 5 years of age. There were 17 (36.9%) deaths. There was 2.3 times more risk of death in the absence of exclusive breastfeeding (OR- 2.3, 95% CI= 0.6-7.9) and 2.2 times higher risk of mortality in the absence of immunization (OR- 2.2, 95% CI=0.6-7.9). Mortality was significantly associated with mechanical ventilation (p<0.0001). Mortality was 17 times higher in children with comorbidities (OR-17, 95% CI= 2-146), 4.7 times higher in children with congenital heart disease (CHD) (OR-4.7 95%CI= 1-22) and 1.3 times higher in children with pre-existing central nervous system (CNS) abnormality (OR-1.33, 95% CI=0.3-6.8). From the respiratory viral panel, 18 (41%) samples were positive for virus detection. Conclusions: In this study 69.5% children with SARI were infants. Mortality was 36.9%. There was a statistically significant increased risk of death in the absence of exclusive breastfeeding, absence of immunization, use of mechanical ventilation, presence of comorbidities, presence of CHD and presence of pre-existing CNS abnormality. Sri Lanka Journal of Child Health, 2023: 52(2): 175-181

Predictors of mortality for patients with hip fracture: a study of the nationwide 1-year records of 24,950 fractures in Romania

The aim of our study was to assess incidence rates for a revision-calibration of the Romanian FRAX tool and to evaluate particularities of hip fracture cases to determine patient- and hospital-related variables affecting mortality. We conducted a retrospective study using hospital reports of hip fracture codes to the National School of Statistics (NSS) from January 1, 2019, until December 31, 2019. The study population included 24,950 patients presenting to Romanian public hospitals in all 41 counties: ≥ the age of 40 with diagnostic ICD 10 codes: S72.0 femoral neck fracture, S72.1 pertrochanteric femoral fracture, and S72.2 subtrochanteric femoral fracture and procedure codes: O11104 (trochanteric/sub capital internal fixation), O12101 (hemiarthroplasty), O11808 (closed femoral reduction with internal fixation), O12103 (partial arthroplasty), O12104 (total arthroplasty). Hospital length of stay (LoS) was classified as follows: < 6, 6-9, 10-14, and ≥ 15days. Incidence of hip fractures was 248/100,000 among those aged 50 + and 184/100,000 within the 40 + age category. Average age of the patients was 77years (80 for females, 71 for males); 83.7% of the patients were 65 + with equivalent urban-rural distributions. Males had a 1.7 times higher mortality risk. Each year increase in age added a mortality risk of 6.9%. In-hospital mortality was 1.34 times higher among patients living in urban areas. Hemiarthroplasty and partial/total unilateral/bilateral arthroplasty had a lower risk of mortality than trochanteric/sub capital internal fixation (p < 0.02, p < 0.033). Gender, age, residence, and procedure type had significant impact on mortality. Updated incidence rates will allow the revision of Romania's FRAX model.

Hospital Frailty Risk Score (HFRS) Predicts Adverse Outcomes Among Hospitalized Patients with Chronic Pancreatitis.

The prevalence of frailty among patients with chronic pancreatitis (CP) and its impact on clinical outcomes is unclear. We report the impact of frailty on mortality, readmission rates, and healthcare utilization among patients with chronic pancreatitis in the United States. We extracted data on patients hospitalized with a primary or secondary diagnosis of CP from the Nationwide Readmissions Database 2019. We applied a previously validated hospital frailty risk scoring system to classify CP patients into frail and non-frail on index hospitalization and compared the characteristics of frail and non-frail patients. We studied the impact of frailty on mortality, readmission, and healthcare utilization. Of 56,072 patients with CP, 40.78% of patients were classified as frail. Frail patients experienced a higher rate of unplanned and preventable hospitalizations. Almost two-thirds of frail patients were younger than 65, and one-third had no or only single comorbidity. On multivariate analysis, frailty was independently associated with two times higher mortality risk (adjusted hazard ratio [aHR], 2.05; 95% CI 1.7-2.5). Frailty was also associated with a higher risk of all-cause readmission with an aHR of 1.07; (95% CI 1.03-1.1). Frail patients experienced a longer length of stay, higher hospitalization costs, and hospitalization charges. Infectious causes were the most common cause of readmission among frail patients compared to acute pancreatitis among non-frail patients. Frailty is independently associated with higher mortality, readmission rates, and healthcare utilization among patients with chronic pancreatitis in the US.

Increased Neutrophil Lymphocyte Ratio Could be Predictive for Higher Mortality in Preterm Infants with Intraventricular Hemorrhage

The neutrophil-to-lymphocyte ratio (NLR) is a simple, cost-effective index of inflammation that can be measured by peripheral blood count. This study aimed to reveal that a high NLR value could be a prognostic marker for mortality risk in preterm babies born with IVH. Preterm babies who had been followed up in the neonatal intensive care unit (ICU) between 2018 and 2020 were included in the study. These patients were examined in two groups, those who had had IVH and those who had not. The patients were evaluated by the week of birth, gender, first-minute APGAR score and NLR obtained from the first postnatal peripheral blood sample. A total of 113 babies had been born preterm and had been treated in the newborn intensive care unit (NICU) were included in the study. Intraventricular hemorrhage (IVH) was observed in 26 (23%) of the infants, and a total of 14 (12.4%) died, with the mortality rate being higher among those with IVH than those without (P= 0.026). There was also a statistically significant difference in the NLR between infants with IVH who died and those who did not (P < 0.001). NLR above 1.5 had 33.7 times higher risk of mortality compared to those with an NLR of 1.5 or below. This was the first study to examine the relationship between the NLR and mortality in preterm babies with IVH. This study showed that a high NLR was strongly associated with mortality in premature infants with low APGAR scores and having IVH.

248: EPIDEMIOLOGY AND OUTCOMES OF PULMONARY HYPERTENSION AMONG PATIENTS WITH TAKAYASU ARTERITIS

Introduction: According to a study published in Journal of Rheumatology, the reported prevalence of secondary pulmonary hypertension (PHTN) in patients with takayasu’s arteritis (TA) varies 13.3% to 61.7% with 7 times higher risk of mortality. But the accurate US national data predicting outcomes of PHTN with TA were limited. Aims: Primary aim of our study was to identify national prevalence and outcomes of PHTN amongst patients with TA. Methods: A population-based cross-sectional study was performed in adult US hospitalizations from the nationwide inpatient sample (NIS-2016-2018). We identified patients with TA and sub-grouped into patients with and without PHTN using ICD-10 codes. Univariate analysis was performed using unpaired students’ t-test and chi-square test to identify prevalence, epidemiology, and outcomes of PHTN amongst TA patients. Mix effects multivariate survey logistic regression analyses weighted for variables were performed to identify outcomes (adjusted odds ratio [aOR] and 95% confidence interval [95%CI]) of PTHN amongst TA. p value < 0.05 was considered as significant. Results: Out of 3560 patients with TA, prevalence of PHTN was 6.04%. PHTN patients were older (58 vs 52 years-old) and highly prevalent in age group >75 years (9.3% vs 18-50 years: 3.55%), female (6.82% vs male:2.88%), Native American (40% and Asian:13.51% vs Black:6.19% vs White: 5.57%), and in emergency admissions (7% vs elective:0.89%). (p< 0.0001) Patients with PTHN had a higher frequency of mortality (4.86% vs 2.12%), morbidity (11.49% vs 5.06%), discharge to non-home (55.79% vs 33.22%), disability (81.82% vs 34.91%), and risk of mortality on discharge (69.67% vs 26.11%).(p< 0.0001) In regression analysis, we found TA as an effect modifier to PHTN for increasing odds of disability [aOR 9.10, 95%CI 3.75-22.12, p=0.0274] and risk of mortality [15.26, 6.17-37.70, p< 0.0001]. Conclusions: Poor outcomes and high disability related burden warrants early identification and risk mitigation of secondary pulmonary hypertension amongst patients with takayasu’s arteritis.

Hospitalization Outcomes of Acute Pancreatitis in Hematopoietic Stem Cell Transplant Recipients.

Acute pancreatitis (AP) carries a significant morbidity and mortality worldwide. AP is a potential complication of hematopoietic stem cell transplantation (HSCT) although its incidence remains unclear. HSCT recipients are at increased risk of AP due to various factors but the effect of AP on mortality and resource utilization in the adult population has not been studied. We investigated the impact of AP on hospitalization outcomes among patients following HSCT. We queried the National Inpatient Sample (NIS) database using the International Classification of Diseases (ICD)-10 codes. All adult patients with a diagnosis or procedure code of HSCT were included in the study. Patients were divided into those with a diagnosis of AP and those without. Sensitivity analysis was performed for patients with a length of stay greater than 28 days. The relationship between AP and mortality, length of stay, total hospitalization cost, and charges was assessed using univariate analysis followed by multivariate analysis. Of the 140,130 adult patients with HSCT, 855 (0.61%) patients developed AP. There was 1.74 times higher risk of mortality in patients with AP as compared to controls (adjusted odds ratio (aOR): 1.74, P = 0.0055). There was no statistically significant difference in the length of stay, hospitalization charge, or cost before sensitivity analysis. After sensitivity analysis, 13,240 patients were included, from which 125 (0.94%) had AP. There was 3.85 times higher risk of mortality in patients who developed AP as compared to controls (aOR: 3.85, P = 0.003). There was a statistically significant increase noted in the length of stay (adj coeff: 20.3 days, P = 0.002), hospital charges (+$346,616, P = 0.017), and cost (+$121,932.4, P = 0.001) in patients with AP as compared to those who did not develop AP. Recipients of HSCT who develop AP have shown to have higher mortality on sensitivity analysis. This study highlights that AP in HSCT patients is associated with worse outcomes and higher resource utilization. Physicians should be aware of this association as the presence of pancreatitis portends a poor prognosis.

Thrombosis in Chronic Kidney Disease in Children.

Venous thromboembolism (VTE) in children is a rare condition. An increased incidence has been observed in the last few years due to several factors, such as increased survival in chronic conditions, especially chronic kidney disease (CKD), use of catheters, and increased sensitivity of diagnostic tools. VTE includes deep vein thrombosis (DVT) and pulmonary embolism (PE). VTE in children is associated with a two to six times higher mortality risk and a 5-10% prevalence of post-thrombotic syndrome. Overall, 5% of VTE episodes in children are associated with chronic kidney disease. The etiology of VTE in chronic kidney disease covers a wide range of pathologies. Various types of thrombotic complications may occur during long-term use of a chronic dialysis catheter. VTE occurs in 3% of children with nephrotic syndrome (NS). The risks for VTE and arterial thromboembolism (ATE) were particularly high in the first 6 months after the onset of NS. Other causes of VTE are graft rejection due to thrombosis of vascular anastomoses after kidney transplantation (3%) and autoimmune diseases (lupus nephritis, antiphospholipid syndrome). In this state-of-the-art overview, we have reviewed the physiologic and pathologic mechanisms underlying pediatric thrombosis and updated current diagnostic and treatment options, emphasizing personal experience as well.

Clinical and prognosis assessment of Atrial Fibrillation patients with significant valvular disease. Validation of the EHRA valve classification (Evaluated Heartvalves. Rheumatic or Artificial)

Abstract Introduction Historically, the definition of valvular heart disease in atrial fibrillation (AF) patients has been inconsistent. For this reason, in 2017 the EHRA proposed a more accurate classification, classifing AF patients in EHRA I (AF patients with mechanical prostheses or moderate/severe rheumatic mitral stenosis), EHRA II (includes the presence of significant valve disease, bioprosthetic valve replacement, TAVR – Transcatheter Aortic Valve Replacement – or mitraclip) and EHRA III (absence of valve involvement). Purpose The objective was to evaluate the prevalence of valve involvement in AF patients, clinical characteristics and adverse outcomes according to new EHRA classification, focusing in the EHRA II vs EHRA III comparison. Methods Observational, multicenter, retrospective study of stable anticoagulated AF patients was performed. Clinical, echocardiographic, demographic characteristics and adverse events after 2 years of follow-up were collected according to EHRA II vs EHRA III groups. Results 981 patients were analyzed: 755 (76.9%) classified as EHRA II [440 (56.8%) with native valve involvement, 134 (17.8%) with surgical biological prostheses and 181 (23.4%) with TAVR] and 226 (23.1%) as EHRAIII. Higher comorbidity profile was observed in the different EHRA II subgroups compared to patients with EHRA III (Table 1). After 2 years of follow-up, the occurrence of adverse events was higher in EHRA-II than EHRA III patients (Figure 1). In the Cox analysis, weo bserved that patients with native valve involvement and TAVR had up to 3 times higher risk of mortality [HR 3.32, (95% CI 1.88–5.85; p&amp;lt;0.001)], 2 times higher risk of Heart Failure [HR 2.14, (95 CI 1.30–3.5; p&amp;lt;0.001)] and MACE [HR 2.01, (95% CI 1.14–3.52; p&amp;lt;0.015)] than EHRA III patients. Conclusion The prevalence of valve involvement in patients with AF is high. Only 23% of AF patients did not present any valve disease. Patients with native valve involvement or TAVR had a high burden of comorbidities and cardiovascular risk factors. Patients with native involvement and TAVR also showed an 2.5-fold increased risk of adverse events during the follow-up. These findings highlight the increased risk related with the presence of valve disease in patients with AF. Funding Acknowledgement Type of funding sources: None.

Survival in patients with congenital heart disease and down syndrome

Abstract Background Increasing survivorship among patients with congenital heart disease (CHD) has been reported during the past decades. However, a number of patients with CHD have an associated Down syndrome diagnosis and the long-term prognosis is still debated. Purpose The aim of the present study was to estimate the mortality risk in CHD patients with Down syndrome compared to a matched control population without CHD. Methods We linked data from the Swedish National Patient Register and Cause of Death Register to identify all CHD patients born between January 1970 and December 2017. Then we identified all CHD patients with Down syndrome. Each CHD patient with Down syndrome was matched for sex and birth year with eight controls without CHD or Down syndrome from the Total Population Register. A Cox proportional regression model was used to estimate the mortality risk and Kaplan Meier for survival analysis. Results In total, 3,285 patients with CHD and Down syndrome and 26,128 matched controls were identified. During a mean follow-up of 16.0 (±12.6) years, 558 CHD patients (17%) with Down syndrome, and 198 controls (0.76%) died. CHD patients with Down syndrome had 25.1 times higher risk of mortality (Hazard ratio 25.1, 95%, confidence interval (CI) 21.3–29.5) compared with controls. Patients with the most complex CHD were found to have the highest mortality risk (Hazard ratio 32.3, 95% CI 26.1–39.9). A decrease in risk of mortality during the first year of life was found between the two birth periods, risk of mortality was 46.8 (CI 29.5–74.0) in 1970–1989 and 17.7 (CI 12.8–24.42) 1990–2017. In addition, the mortality risk was two times (95% CI 1.94–2.31) higher for CHD patients with Down syndrome when compared to CHD patients without Down syndrome. Conclusion The risk of mortality among CHD patients with Down syndrome was 25 times higher compared to controls without CHD or Down syndrome. The highest risk of mortality was found in patients with complex CHD. The survivorship rate was exponentially increased in CHD patients with Down syndrome that were born after 1990, determining the modern era of congenital heart care. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swedish state under an agreement between the Swedish Government and county Councils (ALF)

Cross sectional descriptive study to study the prevalence of metabolic syndrome among patients with epilepsy on antiepileptic drugs in a tertiary care centre

Epilepsy is the commonest neurological condition affecting people of all ages, race and social class. Patients with epilepsy have two to three times higher risk of mortality compared to general population. The role of epilepsy as a potential risk factor for metabolic syndrome and coronary artery disease is of interest.To study the prevalence of metabolic syndrome among patients with epilepsy.This is a hospital based cross-sectional descriptive study. The subjects were selected from patients attending the epilepsy outpatient clinic of a single tertiary centre (GMCH, Udaipur) during the period of 15 months from January 2021 to March 2022. Fasting blood samples were drawn from them to estimate fasting blood glucose and fasting lipid profile.: Males constituted two thirds of the subjects. Average age was 32.5 years. Mean duration of treatment was 13.6 years (range 3–48 years). 51.9% were on monotherapy. Valproate was used in 33 of the 45 (73.33%) patients. In localization related epilepsy, the commonest drug was carbamazepine used in 57.48%. Eight of the enrolled patients had diabetes mellitus and 35 had impaired fasting glucose. Systemic hypertension was detected in 11.5% patients. No significant association was noted between drug use and cardiovascular risk factors – diabetes mellitus, hypertension or dyslipidemia. Very significant association was noted on lipid profile for carbamzepine, phenytoin and clobazam.Antiepileptic medications, especially valproate and carbamazepine have significant effects on the lipid profile and abdominal obesity in patients on treatment. Metabolic syndrome is more prevalent among adult patients &amp;#60;50 years of age with epilepsy compared to the general population in the same age group. This difference could be related to the effect of the antiepileptic medications, especially valproate. There is a need to monitor patients on antiepileptic medications regularly for development of dyslipidemia and obesity.

Comorbidities associated with COVID‑19 mortality: A retrospective study in an intermediate care facility in Cape Town, South Africa

Background. The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic continues to place a significant burden on healthcare systems across the globe. Previous studies have shown that patients with comorbidities who contract SARS-CoV-2 develop more severe COVID‑19 disease and are at a higher risk of mortality. However, literature in the intermediate care setting is limited. Objectives. To evaluate the association between comorbidity and mortality in the intermediate care setting.Methods. A retrospective observational study was performed at Brackengate Intermediate Care Facility (BICF), a 330-bed field hospital, during the second wave of COVID‑19 in Cape Town, South Africa. Data of all adult patients admitted from 1 November 2020 to 28 February 2021 who met the inclusion criteria were analysed. Data were obtained from electronic hospital patient administration systems. Comparisons were made using χ2 or Fisher’s exact testing with a 5% level of confidence used to determine significance. Logistic regression models were used to investigate the independent association between clinical variables of interest and overall mortality.Results. A total of 2 508 patients were analysed, of whom 2 476 (98.7%) were laboratory confirmed cases of COVID‑19. The median number of admissions per day was 14. The mean age was 58 years, and 1 449 (57.8%) were female. The most prevalent comorbidities were hypertension (62.6%), diabetes (46.9%) and obesity (28.0%), while 8.0% of patients were HIV-positive. The overall mortality was 13.3% (333/2 508). Patients with at least one comorbidity were 1.4 times more likely to die (odds ratio (OR) 2.4; 95% confidence interval (CI) 1.6 - 3.5), and this risk increased significantly with cumulative comorbidities. Patients who required &gt;40% oxygen were at 5.5 (95% CI 4.3 - 7.1) times higher mortality risk. Variables independently associated with mortality were age &gt;60 years, FiO2&gt;40%, previous cerebrovascular accident, concurrent tuberculosis infection and chronic kidney disease.Conclusion. Patients with comorbidities are at an increased risk of death in COVID‑19 disease, and should be monitored closely. Oxygen requirement &gt;40% is also associated with a higher likelihood of dying. Intermediate care facilities can provide valuable relief to acute care facilities by admitting high-risk patients for closer monitoring and management.

Impact of the unplanned excision on the oncological outcomes of patients with soft tissue sarcomas: a single-center retrospective review of 490 patients.

This study aimed to (1) compare the oncological results of patients who underwent re-excision after unplanned excision with those who underwent planned excision and (2) analyze the impact of local recurrences on oncological outcomes. Patients with soft tissue sarcoma who had been treated in our center between 2000 and 2018 were retrospectively reviewed. Patients were divided into two groups: Group PE (Planned excision; n=345) and group UE (Unplanned excision; n=145). Two groups were compared in terms of local recurrence-free survival (LRFS), metastasis-free survival (MFS), and overall survival (OS). Local recurrences effects over MFS and OS were also analyzed. There were 26 (17.9%) local recurrences in the UE group and 30 (8.7%) local recurrences in the PE group (P=0.005). There was no difference in MFS and OS between study groups (P=0.278 and P=0.848, respectively). Five years MFS rates of UE and PE groups were 76.4% and 73.6%, and five-year OS rates of UE and PE groups were 70.3% and 73.9%, respectively (P=0.417, P=0.656). Patients with local recurrence had a 1.96 times higher risk of metastasis than patients without local recurrence (P=0.008). Patients with local recurrence had 1.65 times higher risk of mortality than patients without local recurrence (P=0.047). Although local recurrence is much more common in the UE group, this outcome does not seem to affect MFS or OS. These results indicate that similar outcomes can be achieved if UE patients are referred and appropriately treated with wide re-resections. Level III, Therapeutic Study.

Sex disparities in lung cancer survival rates based on screening status

ObjectiveLow dose computed tomography (LDCT) became the standard method for lung cancer (LC) screening in 2013. However, it is unclear whether there are differences in survival rates based on sex and whether the differences depend on screening status. We aimed to evaluate the LC survival rates between females and males based on screening. Material and methodsThis retrospective cohort study examined data from the Boston LC Study (BLCS) between 2013 and 2021. LC screening depends on patients’ demographics (age and smoking history) to determine whether a person is a high-risk individual and, therefore, undergo LDCT. Descriptive statistics were calculated for race, age, histology, smoking history, stage, and treatment. These variables' distributions were compared between sex and screening status using t-test and chi-square, respectively. Cox proportional hazards model and Kaplan-Meier curves were used to compare survival between sex and screening. Propensity score matching was applied to account for selection bias in screening when evaluating the association between screening and stage. ResultsA total of 1,216 LC patients were identified with a screening incidence of 9.4 %, among whom 56 % were female. Unscreened males had 1.59 times higher risk of mortality than unscreened females (P=.0002) and had a worse 5-year survival (male 50 %; 95 %CI, 0.38,0.6 vs female 70 %; 95 %CI,0.62,0.76). In contrast, there were no significant differences in survival between sexes among screened. In a balanced cohort of screened and unscreened, the odds of being diagnosed at late stages for females and smokers were 1.33 and 2.51 times that of males and nonsmokers; however, there were no statistical significance. ConclusionUnscreened females had a lower risk of mortality and better survival than unscreened males, while among the screened population, there was no difference in the overall survival. These observations demonstrate the influence of sex on survival prognosis in LC when screening is not performed.

The survival impact of palliative chemotherapy dose modifications on metastatic colon cancer

BackgroundAn uninterrupted dose of oxaliplatin-based cytotoxic therapy is an essential component in the standard treatment regimen of metastatic colon cancer (mCC). Data on the impacts of dose intensity reduction on the palliative treatment for patients with mCC remain scarce. Hence, this study aimed to investigate the impact of palliative chemotherapy dose modifications (DM) on the survival of patients with mCC.MethodsPatients with stage IV colon cancer who received first-line palliative FOLFOX regimen chemotherapy between 2014 until 2018 in the Oncology Department of the National Cancer Institute were conveniently sampled retrospectively to analyse the treatment efficacy. The cumulative dose and duration of chemotherapy received by the patients were summarised as relative dose intensity (RDI) and stratified as High RDI (RDI ≥ 70%) or Low RDI (RDI < 70%). Progression-free survival (PFS) and 2-year overall survival (OS) between the two groups were analysed using Kaplan-Meier survival analysis and Cox proportional hazards models.ResultsOut of the 414 patients identified, 95 patients with mCC were eligible and included in the final analysis. About half of the patients (n = 47) completed the 12-cycle chemotherapy regimen and one patient received the complete (100%) RDI. The overall median RDI was 68.7%. The Low RDI group (n = 49) had a 1.5 times higher mortality risk than the High RDI group [OS, Hazard Ratio (HR) = 1.5, 95% Cl: 1.19–1.82] with a significant median OS difference (9.1 vs. 16.0 months, p < 0.01). Furthermore, patients with lower dose intensity showed double the risk of disease progression (PFS, HR = 2.0, 95% CI: 1.23–3.13) with a significant difference of 4.5 months of median PFS (p < 0.01). Gender and RDI were the independent prognostic factors of both OS and PFS.ConclusionReduction in the dose intensity of palliative chemotherapy may adversely affect both disease progression and overall survival among mCC patients.

The Impact of Late Secondary Hyperparathyroidism on Mortality in COVID-19 Patients: A Longitudinal Study

Background: Adverse effects of high parathormone hormone (PTH) in critical illness have been described in some studies. Objective: The relationship between high PTH levels with mortality in hospitalized patients with COVID-19 was evaluated in the present study. Methods: A total of 123 patients were included in the study. The patients were evaluated in phase 1 (on admission) and phase 2 (days 4-6 of hospitalization). The patients were categorized into four groups based on the PTH status in both phases: normal PTH1/normal PTH2 (group 1), high PTH1/normal PTH2 (group 2), high PTH1/high PTH2 (group 3), and normal PTH1/high PTH2 (group 4). The multiple logistic regression analysis was performed to examine the independent association of late hyperparathyroidism with mortality. After excluding ineligible participants, 115 patients in phase 1 and 96 patients in phase 2 (days 4-6 of hospitalization) were evaluated. Findings: The level of phase 2 PTH in non-survivors was significantly higher than in survivors (57.5±40.9 pg/mL vs. 27.6±16.2 pg/mL, P=0.001). The mortality rate was significantly higher in high-PTH groups in phase 2 compared to normal-PTH groups in this phase (50% and 42.9% in groups 3 and 4 vs. 6.6% and 18.2% in PTH groups 1 and 2, respectively, P=0.007). Late hyperparathyroidism was associated with 11.4 times higher mortality risk (95% CI: 2.3-56.1, P=0.003). Conclusion: Late hyperparathyroidism remained a significant predictor of mortality after adjusting for the main PTH secretion modulators and disease severity. Late hyperparathyroidism is an independent and strong risk factor for mortality in COVID-19. Further studies are necessary to clarify the mechanisms involved.

Differential associations between body mass index and outcome in different age groups in patients with myocardial infarction

ObjectiveTo investigate the association between age and body mass index (BMI) and mortality in patients with myocardial infarction (MI). Methods We divided 6453 patients into three age groups (<60, 60–75, >75 years) and five BMI categories. Thirty-day and long-term all-cause mortality were assessed. ResultsNo association was found between the BMI category and 30-day mortality in any age group. The association between BMI and long-term multivariable-adjusted mortality risk was age-dependent. Overweight patients had a lower risk than patients with BMI <25 kg/m2 in all age groups (HR 0.62; 95%CI 0.45–0.85; p = 0.003, HR 0.78; 95%CI 0.65–0.93; p = 0.005, HR 0.82; 95%CI 0.70–0.95; p = 0.011 for ages <60, 60–75, >75 years, respectively). The lower risk of death as a function of BMI shifted upward with age, and the risk was also lower in patients with obesity grade I (HR 0.81; 95% CI 0.66–0.98; p = 0.035 and HR 0.78; 95% CI 0.63–0.97; p = 0.023 for ages 60–75, >75 years, respectively). Excessive obesity was harmful only in the oldest group. Patients with obesity grade III had more than a 2.5 times higher mortality risk than patients with BMI <25 kg/m2 only in this group (HR 2.58; 95%CI 1.27–5.24; p = 0.009). An obesity paradox was found in all age groups. ConclusionOur results suggest that moderate weight gain with age improves long-term survival after MI and that the magnitude of this “protective” weight gain is greater in older compared to younger patients. However, excessive weight gain (obesity grade III) is particularly harmful in the oldest age group. The exact relationship between BMI, age, and mortality remains unclear.

FC 104: Apathy Associates with Cognitive Dysfunction and Mortality in Older Ckd Patients

Abstract BACKGROUND AND AIMS The growing population of older patients with chronic kidney disease (CKD) often faces unidentified cognitive impairments and high prevalence of depressive symptoms. Apathy is a clinical syndrome associated with both depression and cognitive decline in community-dwelling older people. Furthermore, apathy has been more often linked to vascular impairments, which are also highly prevalent in the CKD population. However, so far, prevalence and consequences of apathy in older CKD patients have not been studied. We aimed (1) to investigate the prevalence of apathy symptoms in an older population with CKD stage G4/G5 (eGFR &amp;lt; 20 mL/min/1.73 m2), and (2) to assess if apathy is associated with, frailty, cognitive and functional impairments and mood. In addition, we (3) investigated the relation between apathy at baseline and mortality during four years of follow-up. METHOD Data was used from the prospective multicenter COPE (Cognitive Decline in Older Patients with ESKD) cohort, which included CKD patients aged ≥65 years with an eGFR of ≤20 mL/min/1.73 m2. Symptoms of apathy were assessed with the 3-item subscale of the 15-item Geriatric Depression (GDS-3A score ≥2) and depressive symptoms with the remaining items of this scale (GDS-12D ≥2). Frailty, (Fried Frailty Index ≥3), functional dependence (GARS score), handgrip strength and walking speed were measured. Cognitive functioning was assessed by means of global cognition (Mini Mental State Examination), visuoconstruction (Clock drawing), memory (15-Word Verbal Learning Test and Visual Association Test), executive function (Trail Making Test-B) and psychomotor speed (Letter Digit Substitution Test, Trail Making Test -A). Cross-sectional correlations between groups were tested with t-tests, Mann–Whitney and Chi-squared tests. Hazard ratio for mortality was analysed with Cox regression adjusting for age, gender and primary vascular kidney disease. RESULTS In total n = 180 patients, 67% male, were included with a median age of 75.5 years (IQR 71.0–80.9) and mean eGFR of 16.5 (SD 4.6). Symptoms of apathy and isolated apathy (i.e. with no symptoms of depression) were seen in respectively 36% (n = 64) and 17% (n = 30) of the study population. Presence of apathy symptoms at baseline was associated with primary vascular kidney disease (P = 0.031), depression (P &amp;lt; 0.001), frailty (P &amp;lt; 0.001) and decreased physical functioning (i.e. functional dependence; P &amp;lt; 0.001, handgrip strength; P = 0.026 and walking speed; P &amp;lt; 0.001). Presence of apathy symptoms was also associated with reduced executive function (P = 0.045) and psychomotor speed (P = 0.022). Furthermore, patients with apathy symptoms had a 1.9 times higher mortality risk (P = 0.022, adjusted for age, gender and primary vascular renal disease). CONCLUSION Symptoms of apathy occurred in one third of this cohort of older advanced CKD patients. Although apathy was associated with presence of depressive symptoms, half of the cases were not. Apathy is associated with multiple functional and cognitive measures and two-fold increased mortality. Future investigations should focus on cause of apathy and its value in predicting cognitive decline in older CKD patients. Because of the relation of apathy with future outcomes, assessment of apathy might be of value in shared decision making on renal replacement therapy in older CKD patients.

Association between higher variability in kidney function and long-term mortality.

We evaluated whether estimated glomerular filtration rate variability in the general population could be associated with all-cause mortality. Health examination data from 7842 individuals aged >20 years who visited for health check-ups at least thrice at ≥6-month intervals between May 1, 1995 and November 30, 2010 were collected. Estimated glomerular filtration rate variability was defined as the coefficient of variation of the estimated glomerular filtration rate, that is, standard deviation/mean value multiplied by 100. The study population was divided into three groups based on the coefficient of variation tertiles, and the mortality risks were compared across groups. The mean duration from the final visit to the outcome was 10.3 ± 2.9 years. The mean coefficient of variations of estimated glomerular filtration rate variability from the lowest to the highest variability group were 5.1 ± 1.8%, 9.0 ± 1.0%, and 14.4 ± 3.9%, respectively. There was a 1.3 times higher risk of mortality in the group with the highest variability (hazard ratio: 1.300, 95% confidence interval: 1.013-1.669) after adjustment. The findings were similar in patients with diabetes and those >60 years old (hazard ratio: 1.635, 95% confidence interval: 1.076-2.483; hazard ratio: 1.585, 95% confidence interval: 1.107-2.269). Higher estimated glomerular filtration rate variability was associated with increased 10-year mortality in the general population. This variability was very small, but considering the patients' long-term prognoses, it was significant.

Abstract No.: ABS3159: Utility of prognostic scores in prediction of mortality after emergency surgery in COVID-19 patients – A prospective observational cohort study

Background and Aims:Pre-operative prognostic scoring in emergency surgeries is important for informed consent and optimum resource allocation. The accuracy of pre-operative prognostic scores in patients with coronavirus disease (COVID-19) has not been studied. This study aimed to evaluate prognostic scoring tools in COVID-19 patients.Methods:A prospective, observational cohort study was conducted in adults with confirmed COVID-19 infection within 7 weeks before or 1 week after emergency surgery. (1) Demographic data, prognostic risk scores [American Association of Anaesthesiologists Physical Classification (ASA), sequential organ failure assessment (SOFA), quick SOFA (qSOFA), Physiologic and Operative Severity Score for enUmeration of Mortality and Morbidity (POSSUM), and Portsmouth POSSUM (P-POSSUM) scores], and surgical and anaesthetic factors were noted along with morbidity and 30-day mortality. The correlation of prognostic scores and mortality was evaluated using univariate Cox proportional hazards regression, receiver operating characteristic curves (ROCs), Youden’s index, and the Hosmer–Lemeshow goodness-of-fit model.Results:Sixty-seven COVID-19 patients underwent emergency surgery during the study period. The overall mortality was 19%, with the highest in gastro-intestinal/general surgery and sinus surgery. Positive qSOFA and ASA 3E/4E were associated with 9.03 and 12.7 times higher mortality risk, respectively. Each unit increase of SOFA-, POSSUM-, and P-POSSUM-predicted mortality scores led to 50%, 7%, and 6% higher mortality. SOFA, POSSUM, and P-POSSUM area under the curve–ROC curves showed good discrimination between survivors and non-survivors (AUC 0.8829, 0.85, and 0.86, respectively).Conclusion:The overall mortality was comparable to the published literature. (2) SOFA, POSSUM, and P-POSSUM models are good prognostictools for predicting the post-operative 30-day mortality in COVID-19 patients. qSOFA, a simple, clinical, objective tool, also has an aprognostic value.

Elevated K/iCa ratio is an ancillary predictor for mortality in patients with severe hemorrhage: A decision tree analysis

IntroductionTrauma patients receiving massive transfusion protocol (MTP) are at risk of citrate-induced hypocalcemia and hyperkalemia. Here we evaluate potassium (K), ionized calcium (iCa), and K/iCa ratio as predictors of mortality. MethodsThis retrospective study includes all adult trauma patients who received MTP within 1 h at our level I trauma center between 2014 and 2019. Receiver operating characteristic curve analysis assessed predictive accuracy of K/iCa ratio at admission on 120-day mortality. ResultsOf 614 patients, 146 received MTP within 1 h and 38 expired. Patients who expired had higher K/iCa ratio than survivors (median [IQR] = 5.7 [3.8–7.2] vs 3.7 [3.1–4.9], p < 0.001). Area under the curve of K/iCa was 0.72 (95%CI = 0.62–0.82, p < 0.001) with sensitivity = 63.2% and specificity = 77.6%. At the optimum K/iCa cutoff (5.07), patients with high ratios had 4 times higher mortality risk (HR = 3.97, 95%CI = 1.89–8.32, p < 0.001). ConclusionElevated K/iCa ratio was an independent predictor of mortality in trauma patients managed with MTP.