Times Higher Risk Of Mortality Research Articles

Risk of postneonatal mortality, hospitalisation and suboptimal breast feeding practices in low birthweight infants from rural Haryana, India: findings from a secondary data analysis

ObjectivesLow birth weight (LBW) is a risk factor for neonatal mortality and morbidity. It is important to examine whether this risk persists beyond neonatal period. The current secondary data analysis...

Defining Incidence and Risk Factors for Catheter-Associated Bloodstream Infections in an Outpatient Adult Hematopoietic Cell Transplantation Program

Allogeneic hematopoietic cell transplantation (HCT) patients are at an increased risk of developing central line–associated bloodstream infections (CLABSIs) due to prolonged periods of myelosuppression, immunosuppression, and indwelling catheter days. CLABSIs are among the most serious complications in HCT recipients and can lead to prolonged hospitalizations, intensive care unit admissions, lengthy antimicrobial therapies, and increased mortality. There is a lack of data regarding the incidence and risk factors associated with the development of CLABSIs in the HCT population undergoing outpatient transplantation. This was a single-center, retrospective analysis of adult patients who underwent allogeneic HCT between July 2012 and July 2016 in an outpatient transplant unit at a tertiary academic medical center. The primary outcome was the cumulative incidence of CLABSIs from the date of central line placement through the first 100 days post-transplantation. Secondary outcomes included risk factors for CLABSI, number of hospitalizations due to CLABSI, mortality rate at 6 months post-transplantation, and the cumulative incidence, speciation, and presence of multidrug resistance in identified microorganisms. Three hundred fifty-nine patients underwent allogeneic HCT at Vanderbilt University Medical Center and 352 were included for analysis. The cumulative incidence of CLABSIs was 9%, with the majority occurring within the first 30 days post HCT (67%). The use of a matched unrelated donor (MUD) and/or haploidentical donor (odds ratio, 3.993; 95% confidence interval [CI], 1.329 to 12.001; P = .0136) and use of an ablative conditioning regimen (odds ratio, 2.394; 95% CI, 1.052 to 5.446; P = .0374) were independently associated with development of a CLABSI on multivariate analysis. The most common organism implicated in CLABSI was Staphylococcus epidermidis (34%). Patients who developed a CLABSI had an almost 5 times higher risk of mortality at 6 months post-transplantation compared with patients who did not develop a CLABSI (hazard ratio, 4.932; 95% CI, 2.463 to 9.878; P < .001). There is a low incidence of CLABSIs in patients undergoing HCT in the outpatient setting. Patients who underwent HCT using a MUD or haploidentical donor and received ablative conditioning were at higher risk for developing CLABSIs. Overall mortality at 6 months post-transplantation was higher in patients who developed a CLABSI. Additional prospective studies are needed to confirm these observations.

Triiodothyronine levels and mortality in children with sepsis and septic shock

Background Sepsis is the most common cause of death in infants and children. It can cause hormonal imbalances, such as euthyroid sick syndrome (ESS), which may increase the risk of death.Objective To evaluate a possible correlation between the level of triiodothyronine (T3) and mortality in children with sepsis and septic shock.Methods An observational cohort study was conducted on 80 children with sepsis and septic shock from October 2015 until January 2016 in Haji Adam Malik General Hospital, Medan. Subjects underwent PELOD score and T3 examination on the first day admitted in Haji Adam Malik General Hospital. Chi-square test was used to analyze for a correlation between the T3 values and mortality. Results Of the 80 consecutive subjects, 39 (48.75%) had low T3 level on the first day. Of these 39 children, 36 (92.3%) died. Subjects with low T3 level had a 6.31 times higher risk of mortality(PR 6.31; 95%CI 2.99 to 13.28; P&lt;0.001). Of the 31 subjects with high PELOD score, 23 (74.2%) had decreased T3 (PR=2.27; 95%CI 1.45 to 3.57; P&lt;0.001).Conclusion Low T3 level has significant relationship with mortality in children with sepsis and septic shock.

Triiodothyronine levels and mortality in children with sepsis and septic shock

Background Sepsis is the most common cause of death in infants and children. It can cause hormonal imbalances, such as euthyroid sick syndrome (ESS), which may increase the risk of death.Objective To evaluate a possible correlation between the level of triiodothyronine (T3) and mortality in children with sepsis and septic shock.Methods An observational cohort study was conducted on 80 children with sepsis and septic shock from October 2015 until January 2016 in Haji Adam Malik General Hospital, Medan. Subjects underwent PELOD score and T3 examination on the first day admitted in Haji Adam Malik General Hospital. Chi-square test was used to analyze for a correlation between the T3 values and mortality. Results Of the 80 consecutive subjects, 39 (48.75%) had low T3 level on the first day. Of these 39 children, 36 (92.3%) died. Subjects with low T3 level had a 6.31 times higher risk of mortality(PR 6.31; 95%CI 2.99 to 13.28; P&lt;0.001). Of the 31 subjects with high PELOD score, 23 (74.2%) had decreased T3 (PR=2.27; 95%CI 1.45 to 3.57; P&lt;0.001).Conclusion Low T3 level has significant relationship with mortality in children with sepsis and septic shock.

Prognostic factors affecting the mortality of 2nd and 3rd degree burn injuries at a tertiary care center in Indonesia

About two million people suffer from burn injuries in the United States each year, with 100,000 hospitalized in the burn unit. Around 1000 patients suffer from severe burn injuries, with each year average of 300 deaths. Improvements in the understanding of the prognostic factors affecting burn injuries over the past decades have led to advances in medical and surgical treatment. However, comprehensive data on the factors affecting burn injuries in Indonesia have not been available, yet. The aim of the study was to investigate the prognostic factors affecting the mortality of 2nd and 3rd burn injuries patients in Dr. Sardjito General Hospital, Yogyakarta. This was a cross-sectional study conducted within the period of 2007-2011 using secondary data from the Department of Medical Records. Chi-square and logistic regression analysis were used to evaluate the correlation between the prognostic factors and the mortality. A p value 0.05). Furthermore, patients with albumin level 50%, inhalation trauma and hospitalized in 24 hours after the incident were at 22.98, 7.65, 3.0 and 4.59 times higher risk of mortality, respectively (p<0.05). In conclusion, albumin level, burn injury percentage, inhalation trauma and time of arrival are prognostic factors affecting the mortality of the burn injuries patients.

Prognostic predictors of early mortality from exsanguination in adult trauma: a Malaysian trauma center experience

BackgroundTrauma mortality due to exsanguination is the second most common cause of death. The objective of this study is to investigate the predictors for early death from exsanguination.MethodsA prognostic study...

Dementia-associated mortality and its predictors among older adults in sub-Saharan Africa: results from a 2-year follow-up in Congo (the EPIDEMCA-FU study).

between 2011 and 2012, we carried out a study of dementia prevalence in central Africa throughout the EPIDEMCA (Epidemiology of Dementia in Central Africa) programme. to assess dementia-related mortality among Congolese older people from the EPIDEMCA study after 2 years of follow-up. longitudinal population-based cohort study. Gamboma and Brazzaville, Republic of Congo. older participants were traced and interviewed in rural and urban Congo annually between 2012 and 2014. DSM-IV and NINCDS-ADRDA criteria were required for dementia diagnosis. Data on vital status were collected throughout the follow-up. Cox proportional hazards model was used to assess the link between baseline dementia diagnosis and mortality risk. of 1,029 participants at baseline, 910 (88.4%) have a complete cognitive diagnosis. There were 791 participants (76.87%) with normal cognition, 56 (5.44%) with MCI and 63 (6.12%) with dementia. After 2 years of follow-up, 101 (9.8%) participants had died. Compared with participants with normal cognition, patients with dementia had 2.5 times higher mortality risk (HR = 2.53, 95% CI 1.42-4.49, P = 0.001). Among those with dementia, only clinical severity of dementia was associated with an additional increased mortality risk (HR = 1.91; CI 95%, 1.23-2.96; P = 0.004). Age (per 5-year increase), male sex and living in an urban area were independently associated with increased mortality risk across the full cohort. among Congolese older adults, dementia is associated with increased mortality risk. Our results highlight the need for targeted health policies and strategies for dementia care in sub-Saharan Africa (SSA).

Higher CHA2DS2-VASc Score Is Associated With Increased Mortality in Acute Pulmonary Embolism.

CHA2DS2-VASc score has been validated in risk prediction for stroke and thromboembolism in patients with atrial fibrillation (AF). Association of CHA2DS2-VASc score with higher risk of venous thromboembolism and pulmonary embolism (PE) has also been shown. In this study, we investigated the long-term prognostic value of CHA2DS2-VASc score in patients with acute pulmonary embolism (APE). Consecutive patients with APE presenting to our emergency department were retrospectively recruited. Patients with AF and who died secondary to causes other than PE were excluded from the study. The CHA2DS2-VASc score and pulmonary embolism severity index (PESI) were calculated. Two hundred seventy seven participants were included in the study. The mortality rate was 18.7%. Twenty-two cases died within 30 days, and 30 cases died during the follow-up period (median: 13 months). The mean CHA2DS2-VASc score was significantly higher in dead patients compared to survivors (3.61 ± 1.35 vs 1.95 ± 1.52, P < .01). In multivariate regression analysis, systolic pulmonary artery pressure (hazard ratio [HR]: 1.03, 95% confidence interval [CI]: 1.01-1.06, P = .02), PESI score (HR: 1.010, 95% CI: 1.004-1.017, P < .01), and CHA2DS2-VASc score (HR: 1.67, 95% CI: 1.19-2.16, P < .01) were found to be independently correlated with mortality. The patients whose CHA2DS2-VASc score was between 1 and 3 had 5.67 times and patients whose CHA2DS2-VASc score was ≥4 had 16.8 times higher risk of mortality compared to patients with CHA2DS2-VASc score = 0. Patients with higher CHA2DS2-VASc scores had higher rates of mortality after APE.

Emergency Presentation and Short-Term Survival Among Patients With Colorectal Cancer Enrolled in the Government Health Plan of Puerto Rico.

Objective:In this study, we examine factors associated with the use of the emergency room (ER) as an entry point into the health-care system to initiate a cancer diagnosis among Puerto Rico’s Government Health Plan (GHP) patients and compare the 1-year survival of GHP patients that initiated cancer diagnosis in the emergency room (ER) presentation with those that initiated the diagnosis in a physician’s office.Methods:Data for patients with colorectal cancer (CRC) aged 50 to 64 years and diagnosed in 2012 were obtained from the Puerto Rico Central Cancer Registry and linked to the Puerto Rico Health Insurance Administration database (n = 190). Crude odds ratio, adjusted odds ratio, and their 95% confidence intervals were reported. We used the Kaplan-Meier method to generate survival curves. Multivariate Cox regression analysis was performed to evaluate the association between ER presentation and 1-year cause-specific survival.Results:We found that 37.37% of the study population had an ER presentation. Male patients had a higher occurrence of having an ER presentation (66.20%), while 76.06% of the patients with an ER presentation were diagnosed in late stage. Emergency room presentation was a highly predictive factor for cancer mortality in the year following the diagnosis. These patients had between 3.99 to 4.24 times higher mortality risk than non-ER presentation patients (P < .05).Conclusion:Late presentation for CRC diagnosis through an ER visit is a significant concern that influences negatively on the patient’s outcome. Efforts at increasing primary care visits and routine screening tests among GHP beneficiaries could improve survival.

Post-nuclear disaster evacuation and survival amongst elderly people in Fukushima: A comparative analysis between evacuees and non-evacuees

BackgroundConsidering the health impacts of evacuation is fundamental to disaster planning especially for vulnerable elderly populations; however, evacuation-related mortality risks have not been well-investigated. We conducted an analysis to compare survival of evacuated and non-evacuated residents of elderly care facilities, following the Great East Japan Earthquake and subsequent Fukushima Dai-ichi nuclear power plant incident on 11th March 2011. ObjectiveTo assess associations between evacuation and mortality after the Fukushima nuclear incident; and to present discussion points on disaster planning, with reference to vulnerable elderly populations. MethodsThe study population comprised 1,215 residents admitted to seven elderly care facilities located 20–40km from the nuclear plant in the five years before the incident. Demographic and clinical characteristics were obtained from medical records. Evacuation histories were tracked until mid 2013. Main outcome measures are hazard ratios in evacuees versus non-evacuees using random-effects Cox proportional hazards models, and pre- and post-disaster survival probabilities and relative mortality incidence. ResultsExperiencing the disasters did not have a significant influence on mortality (hazard ratio 1.10, 95% confidence interval: 0.84–1.43). Evacuation was associated with 1.82 times higher mortality (95% confidence interval: 1.22–2.70) after adjusting for confounders, with the initial evacuation from the original facility associated with 3.37 times higher mortality risk (95% confidence interval: 1.66–6.81) than non evacuation. ConclusionsThe government should consider updating its requirements for emergency planning for elderly facilities and ensure that, in a disaster setting, these facilities have the capacity and support to shelter in place for at least sufficient time to adequately prepare initial evacuation.

One-year mortality rate after osteoporotic hip fractures and associated risk factors in Police General Hospital

ObjectivesThe purpose of this study was to investigate the mortality rate and other associated risk factors a year after diagnosis of osteoporotic hip fracture. MethodsA prospective cohort study was carried out in 120 patients who were at least 50 years of age who presented with a hip fracture caused by a simple fall and were admitted to Police General Hospital in 2013. Background data, mortality rate and associated risk factors were collected and evaluated. ResultsThere were 88 females (73.33%) and 32 males (26.67%). The average age was 79.4 years. Eleven patients were deceased by the end of this study. The mortality rate was about 3.3 times higher when compared to the general population in the same age range (9.2% vs 2.28%). The survival rates for both sexes at 6 weeks, 6 months and 12 months after fracture were 94.2%, 93.3% and 90.8%, respectively. Higher mortality was associated with non-operative treatment only. Patients who were treated non-operatively had a 3.93 times higher mortality risk when compared to those who were treated operatively (23.8% vs 6.1%). ConclusionsThis study shows that the one-year mortality rate of osteoporotic hip fracture patients who were 50 years or older was 9%. However, the rate increased after an osteoporotic hip fracture, especially within the first year post-fracture. Higher mortality was associated with non-operative treatment only while the other variables were not.

Associations of drug burden index with falls, general practitioner visits, and mortality in older people.

On a population level in people aged ≥65 years old living in New Zealand, the aim of this study is to quantify each individual's cumulative exposure to anticholinergic and sedative medicines using the Drug Burden Index (DBI) and examine the impact of DBI on fall-related hospitalisations, general practitioner (GP) visits, and all-cause mortality. The study used data extracted from Pharmaceutical Claims Data Mart (2011), National Minimum Data set (2012), Births, Death and Marriages (2012) and GP Visits (2012) for patient demographics, hospitalisations and mortality. Cumulative anticholinergic and sedative exposure was measured using the DBI. Polypharmacy was defined as greater than or equal to five medicines dispensed concurrently at any time during the study period. Amongst the study population (n = 537,387; 45% male), 43.22% were exposed to DBI drugs (95% confidence intervals (CIs) = 43.09-43.35). The odds of DBI exposure for individuals with polypharmacy are 4.92 (95%CI = 4.86-4.98) times greater than that for individuals without polypharmacy. DBI drugs were associated with fall-related hospitalisations (incidence rate ratio (IRR) 1.56, 95%CI = 1.47-1.65) and greater number of GP visits (IRR 1.13, 95%CI = 1.12-1.13). Individuals with DBI > 0 had a 1.29 times higher mortality risk (95%CI = 1.25-1.33). Polypharmacy is also associated with a higher mortality risk with a hazard ratio (HR) of 1.66 (95%CI = 1.59-1.73). Polypharmacy and exposure to DBI drugs were independently associated with fall-related hospitalisations, frequency of GP visits, and risk of mortality. On a population level, DBI may be useful as a quality indicator to guide policy to improve prescribing and optimize clinical outcomes in older people.

Implementation of Telephone-Based Secondary Preventive Intervention after Stroke and Transient Ischemic Attack - Participation Rate, Reasons for Nonparticipation and One-Year Mortality

Background and Purpose: Patients who experience a stroke or transient ischemic attack (TIA) are known to be at high risk of subsequent vascular events, underscoring the need for secondary preventive intervention. However, previous studies have indicated insufficiency in the implementation of secondary prevention, emphasizing the need to develop effective methods of follow-up. In the present study, we examined the potential of implementing a telephone-based, nurse-led, secondary preventive follow-up in stroke and TIA patients on a population level by analyzing the participation rate, reasons for nonparticipation, and one-year mortality. Methods: Between January 1, 2010 and December 31, 2011, all patients admitted to Östersund hospital, Sweden, and diagnosed with either stroke or TIA were considered for inclusion into the secondary preventive follow-up. Baseline data were collected at the hospital, and reasons for nonparticipation were documented. Multivariate logistic regression was performed to identify predictors of the patient decision not to participate and to explore independent associations between baseline characteristics and exclusion. A one-year follow-up of mortality was also performed; the survival functions of the three groups (included, excluded, declining participation) was calculated using the Kaplan-Meier estimator. Results: From a total of 810 identified patients, 430 (53.1%) were included in the secondary preventive follow-up, 289 (35.7%) were excluded mainly due to physical or cognitive disability, and 91 (11.2%) declined participation. Age ≥85 years, ischemic and hemorrhagic stroke, modified Rankin scale score >3, body mass index ≥25, congestive heart failure, and lower education level were independently associated with exclusion, whereas lower education level was the only factor independently associated with the patient decision not to participate. Exclusion was associated with a more than 12 times higher risk of mortality within the first year after discharge. Conclusion: Population-based implementation of secondary prevention in stroke and TIA patients is limited by the high prevalence of comorbidity and a considerable degree of disability. In our study, a large proportion of patients were unable to participate even in this simple form of secondary preventive follow-up. Exclusion was associated with substantially higher one-year mortality, and education level was independently associated with physical ability as well as the motivation to participate in the secondary preventive follow-up program.

Ocular manifestations of head injury and incidence of post-traumatic ocular motor nerve involvement in cases of head injury: a clinical review

As the eyes are in close proximity to the skull, they can get simultaneously affected in head injuries. This close association warrants careful ocular examination in all cases of head injury. This is a prospective non-randomized analytical study to evaluate various ocular manifestations in cases of head injury with special reference to ocular motor nerve involvement, correlation between pupillary changes, and survival. A total of 1,184 patients with head injury were screened for ocular manifestations. This study comprises 594 patients with ocular manifestations of head injury. All the relevant data was compiled and analyzed as per proforma. Ocular manifestations were evaluated in each patient and appropriate investigations were carried out. Patients with ocular morbidity were analyzed for age, sex, mode of injury, Glasgow Coma Score, and associated injuries in addition to ophthalmic and neurosurgical evaluations. Of the 594 patients, 81.6 % were male and 18.4 % were female, with a male-to-female ratio of 4:1. The major cause of head injury was road traffic accidents (70.37 %). The most common age group involved was, 21-40-year-olds (67.40 %). Out of 594 patients, ecchymosis was found in 51.85 %, subconjunctival hemorrhage in 44.44 %, lid edema in 41.48 %, lacerated wound in 22.59 %, pupillary involvement in 21.04 %, ptosis in 6.73 %, cranial nerve palsy in 11.62 %, orbital fractures in 10.44 %, optic nerve trauma in 4.04 %, and exposure keratitis in 4.21 %. Patients with bilaterally dilated or pinpoint fixed pupils had a 10 times higher risk of mortality than patients without pupillary involvement. Third nerve involvement was seen 2.85 times more frequently in frontal and parietal region injuries compared to other sites of injury. The involvement of the sixth nerve occurred 4.6 times more frequently in parietal region injuries compared to other sites of injury.

Efficacy of Mannheim Peritonitis Index (MPI) Score in Patients with Secondary Peritonitis.

Despite advances in diagnosis, management and critical care of patients with peritonitis due to hollow viscus perforation, prognosis remains poor. Early assessment by scoring systems will influence the management and prognosis. Evaluation of Mannheim Peritonitis Index (MPI) score for predicting the outcome in patients with peritonitis. Prospective study of 50 patients admitted and operated for peritonitis in JSS Medical College Hospital. The structured scoring system i.e. MPI was applied along with other clinical and biochemical parameters recorded in pre-structured proforma. Data was analysed for predicting mortality and morbidity using EPI info and SPSS software. The overall mortality and morbidity was 14% and 38% respectively. MPI scores of ≤ 20, 21-29, and ≥ 30 had a mortality of 5%, 14%, and 50% respectively. MPI score of 25 had highest sensitivity of 72.09% and specificity of 71.43% in predicting mortality, 80.65% sensitivity and 57.89% specificity for morbidity. MPI score of > 25 were associated with 6.45 times higher risk of mortality (p=0.03), 5.72 times higher risk of morbidity (p=0.005) compared to patients with MPI score ≤ 25. MPI is disease specific, easy scoring system for predicting the mortality in patients with secondary peritonitis. Increasing scores are associated with poorer prognosis, needs intensive management and hence it should be used routinely in clinical practice.

Plasma adiponectin in heart failure with and without cachexia: Catabolic signal linking catabolism, symptomatic status, and prognosis

Background and aimsAdiponectin (ADPN) as an adipose tissue hormone contributes to regulation of energy metabolism and body composition and is associated with cardiovascular risk profile parameters. Cardiac cachexia may develop as a result of severe catabolic derangement in chronic heart failure (CHF). We aimed to determinate an abnormal ADPN regulation as a link between catabolic signalling, symptomatic deterioration and poor prognosis. Methods and resultsWe measured plasma ADPN in 111 CHF patients (age 65 ± 11, 90% male, left ventricular ejection fraction (LVEF) 36 ± 11%, peak oxygen consumption (peakVO2) 18.1 ± 5.7 l/kg*min, body mass index (BMI) 27 ± 4 kg/m2, all mean ± standard deviation) and 36 healthy controls of similar age and BMI. Body composition was assessed by dual energy X-ray absorptiometry, insulin sensitivity was evaluated by homoeostasis model assessment, exercise capacity by spiroergometry. Plasma ADPN did not differ between CHF vs. controls (13.5 ± 11.0 vs. 10.5 ± 5.3 mg/l, p > 0.4), but increased stepwise with NYHA functional class (I/II/III: 5.7 ± 1.4/10.7 ± 8.3/19.2 ± 14.0 mg/l, ANOVA p < 0.01). Furthermore, ADPN correlated with VO2 at anaerobic threshold (r = −0.34, p < 0.05). ADPN was highest in cachectic patients (cCHF, 16%) vs. non-cachectic (ncCHF) (18.7 ± 15.0 vs. 12.5 ± 9.9 mg/l; p < 0.05). ADPN indicated mortality risk independently of established prognosticators (HR: 1.04 95% CI: 1.02–1.07; p < 0.0001). ADPN above the mean (13.5 mg/l) was associated with a 3.4 times higher mortality risk in CHF vs. patients with ADPN levels below the mean. ConclusionCirculating ADPN is abnormally regulated in CHF. ADPN may be involved in impaired metabolic signalling linking disease progression, tissue wasting, and poor outcome in CHF.

Spinal cord injuries related to cervical spine fractures in elderly patients: factors affecting mortality

Background contextSpinal cord injuries (SCIs) related to cervical spine (C-spine) fractures can cause significant morbidity and mortality. Aggressive treatment often required to manage instability associated with C-spine fractures is complicated and hazardous in the elderly population. PurposeTo determine the mortality rate of elderly patients with SCIs related to C-spine fractures and identify factors that contribute toward a higher risk for negative outcomes. Study design/settingRetrospective cohort study at two Level 1 trauma centers. Patient sampleThirty-seven consecutive patients aged 60 years and older who had SCIs related to C-spine fractures. Outcome measuresLevel of injury, injury severity, preinjury medical comorbidities, treatment (operative vs. nonoperative), and cause of death. MethodsHospital medical records were reviewed independently. Baseline radiographs and computed tomography or magnetic resonance imaging scans were examined to permit categorization according to the mechanistic classification by Allen and Ferguson of subaxial C-spine injuries. Univariate logistic regression analyses were performed to identify factors related to in-hospital mortality and ambulation at discharge. There were no funding sources or potential conflicts of interest to disclose. ResultsThe in-hospital mortality rate was 38%. Respiratory failure was the leading cause of death. Preinjury medical comorbidities, age, and operative versus nonoperative treatment did not affect mortality. Injury level at or above C4 was associated with a 7.1 times higher risk of mortality compared with injuries below C4 (p=.01). Complete SCI was associated with a 5.1 times higher risk of mortality compared with incomplete SCI (p=.03). Neurological recovery was uncommon. Apart from severity of initial SCI, no other factor was related to ambulatory disposition at discharge. ConclusionsIn this elderly population, neurological recovery was poor and the in-hospital mortality rate was high. The strongest risk factors for mortality were injury level and severity of SCI. Although each case of SCI related to C-spine fractures is different, physicians may be able to use these findings to help better determine the prognosis and guide subsequent treatment.

Abstract TP180: Markedly Elevated High-sensitive C-reactive protein (hsCRP) Predicts Early Mortality Among Stroke Patients

Background: High-sensitive C-Reactive Protein (hsCRP) levels are correlated with risk of vascular disease and cardiovascular mortality. The clinical implications of markedly elevated hsCRP levels in the setting of acute stroke are less understood as they are often excluded from studies. Objective: To determine the association of very high admission hsCRP levels (&gt; 10mg/L) on all-cause mortality in patients with acute stroke Methods: We performed a retrospective cohort study of patients admitted to our institution with acute stroke (8/2003- 11/2011) who had at least one hsCRP assay drawn &lt; 7 days of stroke diagnosis. Mortality data was obtained using Social Security Death Index. Differences in survival were determined using Kaplan-Meier curves. Cox proportional analysis was used to determine hazard ratios of death among patients with hsCRP values &gt; 10 mg/L after adjusting for age, sex, race and the following co-morbid conditions: cancer, atrial fibrillation, diabetes, hypertension, myocardial infarction Results: There were 293 stroke patients identified with hsCRP levels drawn &lt; 7 days of stroke admission. Median age was 65.7 years (SD 15.3), and 55% were male. All-cause mortality was 18% (n=53) with a median follow-up of 2.2 years. Median hsCRP level was 5.5 mg/L, [IQR 1.8 - 14.6] with 31.7% patients having hsCRP &gt; 10 mg/L. Patients with hsCRP &gt; 10 mg/L had a 2.7 times higher risk of mortality than those with hsCRP &lt; 10 mg/L (p=0.004). The increased risk was steepest in the first months after stroke (Figure). The only other significant variable affecting hazard for death was age; each year increased the hazard ratio by 3.3%. Of the cases in which cause of death was known (n=31), stroke was the most common cause (71%) Conclusion: Very high level of hsCRP (&gt;10 mg/L) at the time of admission is associated with increased early mortality among patients presenting with acute strokes. This finding may help stratify risk of death in stroke.

Roma ethnicity and clinical outcomes in kidney transplant recipients

Racial and ethnic disparities among North American patients with chronic kidney disease have received significant attention. In contrast, little is known about health-related outcomes of patients with end-stage renal disease among the Roma minority, also known as gypsies, compared to Caucasian individuals. We prospectively assessed the association between Roma ethnicity and long-term clinical outcomes in kidney transplant recipients. In a prevalent cohort of renal transplant recipients, followed up over a median of 94 months, we prospectively collected socio-demographic, medical (and transplant related) characteristics and laboratory data at baseline from 60 Roma and 1,003 Caucasian patients (mean age 45 (SD = 11) and 49 (SD = 13) years, 33 and 41% women, 18 and 17% with diabetes mellitus, respectively). Survival analyses examined the associations between Roma ethnicity and all-cause mortality and death-censored graft loss or death with functioning renal allograft. During the follow-up period, 341 patients (32%) died. Two-hundred eighty (26%) patients died with a functioning graft and 201 patients (19%) returned to dialysis. After multivariable adjustments, Roma ethnicity was associated with 77% higher risk of all-cause mortality (Hazard Ratio (HR): 1.77; 95% confidence interval (CI): 1.02, 3.07), two times higher risk of mortality with functioning graft (2.04 [1.17-3.55]) and 77% higher risk of graft loss (1.77 [1.01-3.13]), respectively. Roma ethnicity is independently associated with increased mortality risk and worse graft outcome in kidney transplant recipients. Further studies should identify the factors contributing to worse outcomes among Roma patients.

Aspects of esophageal atresia in a population-based setting: incidence, mortality, and cancer risk

To estimate the incidence, mortality and cancer risk of the congenital malformation esophageal atresia (EA) in a population-based investigation. A population-based cohort study of EA patients registered in three nationwide registers in Sweden in 1964-2007. The incidence of EA per total number of live births was assessed. Mortality and cancer occurrence were expressed as standardized mortality ratio (SMR) and standardized incidence ratio (SIR) with 95% confidence intervals (CI). Mortality was further analyzed by Cox regression and expressed as hazard ratio with 95% CI. The EA cohort comprised 1,126 patients. The mean incidence was 3.16 per 10,000 live births, without any temporal changes (p for trend =0.94). Associated anomalies were present in 42% and chromosomal abnormalities in 5%. EA patients had an almost 12 times higher risk of mortality compared to the background population (SMR 11.8, 95% CI 10.3-13.5). The mortality increase was most pronounced during the first 5 years after birth. Survival improved during the study period (p for trend =0.0001). EA did not entail a strongly increased cancer risk (SIR 0.9; 95% CI 0.2-2.6). EA has a stable incidence, the survival has improved substantially during recent decades, and the cancer risk might not be increased.