Total Mortality Research Articles

Meta-analysis of the association between low concentration PM2.5 and cardiovascular mortality in the United States and Canada

Objectives The adverse effects of fine particulate matter (PM2.5), including cardiovascular outcomes, are well established. This review and meta-analysis investigates the association between long-term exposure to low concentration PM2.5 (<12 µg/m3) and CVD mortality in U.S. and Canadian populations. Methods We conducted a literature search and completed random effect meta-analyses. Results Twenty-four studies were reviewed, with 12 from each of the U.S. and Canada. Fifteen of eighteen studies that reported hazard ratios (HRs) for total CVD mortality reported statistically significant positive associations with low concentration PM2.5. For cause-specific CVD mortality, more consistent results were shown for ischemic heart disease (IHD) mortality, with all eleven studies reporting statistically significant associations (HR = 1.09 to 2.48). Only three of 12 studies evaluating cerebrovascular mortality reported statistically significant associations (HR = 1.10 to 1.27). Studies that restricted analyses to participants with mean exposures <12 µg/m3 found statistically significant associations between PM2.5 and at least some of the CVD mortality outcomes of interest. However, the shape of the concentration-response functions varied widely. Only six studies controlled for at least one additional air pollutant, and multi-pollutant models generally showed an attenuated impact of PM2.5. Despite existing gaps in understanding the association between low concentrations of PM2.5 and cardiovascular mortality, this review highlights the critical importance of ongoing efforts to improve air quality for public health benefits. Conclusions Continued focus on understanding the shape of the concentration-response function for PM2.5, the impact of co-pollutants on observed effects, and how particle composition may impact effect estimates, is recommended.

Clinical Characteristics and Short-Term Outcomes of COVID-19 Positive Hospitalized Hemodialysis Patients

Presentation of Novel Corona virus disease (COVID-19) and its clinical features and outcomes were different in maintenance hemodialysis (MHD) patients than in general population due to relative immunosuppression and high prevalence of co-morbidities in MHD patients. The aim of this study is to identify the clinical characteristics and outcome of MHD patients requiring hospitalization for COVID 19. In this retrospective observational study, a total of 100 adult patients of both sex who were on maintenance hemodialysis therapy having A-V fistula or permanent venous catheter admitted in Nephrology department of Mugda Medical College Hospital due to COVID-19 from April 21, 2020 to April 30, 2021 were included. Demographic data (age, sex, comorbidities), initial clinical presentations (fever, cough, shortness of breath, fatigue), oxygen saturation, chest radiograph and laboratory tests CBC, RBS, Serum Creatinine, SGPT, CRP, LDH, D dimer, Ferritin, Albumin at admission and during hospital stay were retrieved from patient file. Treatment of these hemodialysis patients was given and modified according to the hospital treatment committee including Nephrologist and Medicine specialist. As the patients were followed up from admission in hospital until discharge or death, so they were divided in two groups- Survived and death. All data were compiled and edited meticulously using SPSS version 27 software. The mean age of the patients was 53.8±13.3 (Range 15-90). Male and female ratio was 1.7.1. No significant difference was observed regarding age and sex of the study subjects. Most patients had HTN (78%) followed by DM (52%), IHD (42%), CLD (24%), pulmonary disease (21%) and Stroke (6%). The most common symptoms during admission in hospital were fever 65%, cough 52%, fatigue 43%, SOB 35% and diarrhea 8% respectively. Fever, cough, fatigue and SOB and in case of co-morbidities only IHD were statistically significant. Mean Oxygen saturation during admission was statistically significantly lower in death group (96.0±1.32 vs 90.2±2.9; p&lt;0.001). Regarding biochemical parameters lymphocyte count (1058.4±289.3 vs 2575.9±536.6 p &lt;0.001), albumin (3.38±0.80 vs 3.89±0.57; p&lt;0.001) were statistically significantly low and N:L ratio (10.48±2.77 vs 3.24±0.40; p&lt;0.001), creatinine (9.75±2.28 vs 6.11±2.27; p&lt;0.001), CRP (33.09±12.99 vs 13.29±5.35; p&lt;0.001), LDH (367.09±78.25 vs 294.06±58.1; p&lt;0.001) were significantly high in death group. Lung abnormalities on CXR PA view showed normal CXR in 48.7% patients in survived group and bilateral GGO in 68.2% in death group which were also statistically significant. Outcome of these admitted patients revealed total death rate 22%, ICU admission rate 18% and discharge from hospital rate was 78%. Logistic regression of these risk factors regarding mortality in COVID19 showed oxygen saturation (p=0.00), N:L ratio (p=0.00), and CRP (p=0.035) were statistically significant. In this study, we found a high mortality rate in COVID 19 positive hospitalized maintenance hemodialysis patients. Markers of inflammation neutrophil-to-lymphocyte ratio (N:L ratio), CRP and oxygen status are significant predictors of COVID 19 patients’ morbidity, highlighting the importance of monitoring these parameters for clinical management and risk stratification. Mugda Med Coll J. 2024; 7(2): 58-65

Molecular characterization, chemical profile and biological properties of essential oils from Chamaemelum nobile (L.) flowers of Morocco: in vitro and in silico studies

IntroductionThis study investigated the antioxidant, antimicrobial, and insecticidal properties of Chamaemelum nobile (L.) essential oil (CN-EO), harvested in Taounate, Morocco. The molecular composition and chemical profile of CN-EO were also characterized.MethodsThe CN-EO was extracted using a Clevenger apparatus. Its chemical composition was analyzed using gas chromatography-mass spectrometry (GC-MS). Antioxidant activity was evaluated using the DPPH assay, while antimicrobial properties were assessed via the disk diffusion method to measure inhibition zones against various bacterial and fungal strains. Insecticidal activity was tested through bioassays to determine insect mortality and repellency rates. Phylogenetic analysis of DNA sequences was conducted to confirm the species identity.ResultsGC-MS analysis identified 24 compounds in CN-EO, with β-Oplopenone (18.66%), Spathulenol (14.90%), and Himachalene (12.47%) as major constituents. CN-EO exhibited strong antioxidant activity (IC50 = 135.8 ± 1.03 μg/mL). Antimicrobial assays revealed inhibition zones of up to 20.67 ± 0.58 mm (Staphylococcus aureus) and antifungal inhibition of 40.42% ± 2.82% against Aspergillus flavus. Insecticidal tests showed total insect mortality at 166 µL/L within 48 h and a 60% repellent effect. Phylogenetic analysis of the DNA sequence revealed a 99.22% similarity with Chamaemelum nobile (L.).ConclusionThese results demonstrate the significant potential of Moroccan CN-EO in phytomedicine. It exhibits a wide range of biological activities and shows great promise as a natural antioxidant, antimicrobial agent, antifungal, and insecticide.

Predictive Factors of Cardiac Function Recovery and Mortality in Patients with Reduced Ejection Fraction Undergoing Transcatheter Aortic Valve Implantation

Background and Objectives: Patients with reduced left ventricular ejection fraction (LVEF) are reported to have unfavorable outcomes following transcatheter aortic valve implantation (TAVI). This study aims to evaluate outcomes and identify predictive factors for LVEF recovery following TAVI in patients with reduced LVEF. Materials and Methods: This retrospective study analyzed 114 patients with symptomatic severe aortic stenosis (AS) with LVEF &lt; 40% who underwent TAVI between 2011 and 2023 at two centers. Echocardiographic parameters, including LVEF, ventricular dimensions, and relative wall thickness (RWT), were assessed at baseline and during follow-up. The outcomes and predictors of substantial LVEF improvement and mortality were analyzed using univariate and multivariate logistic regression methods. Results: Anemia (OR = 4.345, 95% CI: 1.208–15.626, p = 0.024), RWT (OR = 1.224, 95% CI: 1.064–1.407, p = 0.005), and early post-procedural changes in left ventricular end-systolic dimension (LVESD) (OR = 1.297, 95% CI: 1.037–1.622, p = 0.023) and left ventricular end-diastolic dimension (LVEDD) (OR = 1.346, 95% CI: 1.034–1.753, p = 0.027) at one-month follow-up were identified as significant factors associated with LVEF recovery at one year. Regarding factors related to mortality, higher baseline AVMG levels were associated with a lower probability of death after one year (OR = 0.926, 95% CI: 0.875–0.979, p = 0.007). Conversely, a more limited increase in LVEF from baseline to the final follow-up was linked to poor prognosis and higher mortality at one year (95% CI: 1.045–1.594, p = 0.018). Conclusions: This study demonstrated that TAVI in patients with AS and reduced LVEF can be performed with high procedural success, low mortality, and significant improvement in cardiac function during follow-up. Additionally, anemia, baseline RWT, and early post-procedural changes in LVESD and LVEDD were identified as factors associated with LVEF recovery. Baseline AVMG and changes in LVEF at the final follow-up were found to be significant predictors of total mortality.

Vitamin and dietary supplements are not associated with total or cardiovascular mortality in Switzerland: the CoLaus|PsyCoLaus prospective study

PurposeVitamin-mineral and dietary supplements (VMDS) are taken by a large fraction of the population. Whether their long-term consumption impacts mortality and cardiovascular disease (CVD) has seldom been studied.MethodsProspective study from a population-based cohort from Lausanne, Switzerland. Participants were categorized as non-users (no consumption at baseline and first follow-up), persistent users (consumption at baseline and follow-up), and occasional users (consumption either at baseline or follow-up). Incidence of CVD and of total mortality was assessed after the first follow-up.ResultsData from 4261 participants (57.4 ± 10.4 years, 55% females) was used. Median follow-up was 9 years (interquartile range 7.0–9.2) After multivariable analysis, no association was found between VMDS use and total mortality: hazard ratio and (95% confidence interval) 0.95 (0.71–1.28) and 0.83 (0.55–1.26) for occasional and persistent consumers, respectively, CVD mortality: 1.00 (0.47–2.11) and 1.30 (0.53–3.18), or CVD events: 0.96 (0.72–1.27) and 0.95 (0.64–1.42). Similar findings were obtained after inverse probability weighting, using only vitamin-mineral supplement users, or considering only participants at baseline. When CVD events were split into coronary heart disease (CHD) or stroke, persistent use of VMDS was associated with a higher risk of CHD in females: 3.12 (1.52–6.41), p = 0.002, but not in males, 0.25 (0.03–1.82), p = 0.171, p for interaction < 0.05. No association was found between VMDS use and incidence of stroke in both sexes.ConclusionWe found no association between vitamin and dietary supplement use and total or CVD mortality, or CVD events. The higher risk of CHD for persistent use in females should be further explored.

Low-carbohydrate diet score and risk of mortality: The Japan Collaborative Cohort Study.

A low-carbohydrate diet (LCD) may be effective for reducing cardiovascular disease (CVD) risk factors. However, its association with mortality remains unclear, especially in populations with higher carbohydrate and lower fat intake. This study aimed to evaluate the association between LCD scores and mortality risk in participants from the Japan Collaborative Cohort Study. The analysis included 22,659 men and 35,192 women aged 40-79 years at baseline. A food frequency questionnaire was used to construct the LCD scores, which were further categorized into 3 types based on the fat intake source: animal, fish, and plant. The association between the LCD scores and total and cause-specific mortality was estimated using the Cox proportional hazards model adjusted for confounders. During a median follow-up period of 19.4 years, 10,835 deaths (5835 men and 5000 women) were recorded. For all participants, the overall LCD score was inversely associated with total mortality. The lowest hazard ratio (95% confidence interval) was 0.85 (0.78-0.93) in the eighth decile (P for linear trend = 0.03). Fish fat-based LCD score had a U-shaped association with total mortality (P for non-linear trend = 0.01). An inverse association was observed with CVD mortality (P for linear trend = 0.04 of overall LCD score; P for linear trend = 0.04 of fish fat-based LCD score). In women, there was an inverse association between the overall LCD score and total mortality. A U-shaped association was also shown for fish fat-based LCD score. The fish fat-based LCD score was inversely associated with CVD mortality. Moderate overall and fish fat-based LCD scores were associated with a lower risk of total mortality in the Japanese population. Fish fat-based LCD score had a significant inverse association with CVD mortality.

Impact of surrogates for insulin resistance on mortality and life expectancy in primary care: a nationwide cross-sectional study with registry linkage (LIPIDOGRAM2015).

Insulin resistance (IR) is an important risk factor for multiple chronic diseases, increasing mortality and reducing life expectancy. The associations between emerging surrogates for IR, triglyceride-glucose index (TyG) and TyG-related indicators, with all-cause mortality and life expectancy in middle-aged and older patients in primary care are unclear. This study originated from the Polish primary care cohort LIPIDOGRAM2015, including patients aged ≥45 years. Baseline fasting triglycerides and fasting glucose were used to derive TyG. Other TyG-related indicators included TyG-adjusted body mass index (TyG-BMI), TyG-adjusted waist circumference (TyG-WC), TyG-adjusted waist-to-hip, and TyG-adjusted waist-to-height. In this longitudinal analysis, we assessed associations between TyG-related indicators with total all-cause mortality, premature (age at death ≤75 years) all-cause mortality and years of life lost (YLL). We included 10,688 patients (mean age 61.8±9.3 years; 63.5% female). Cumulative total and premature all-cause mortality were 7.2% and 4.6%, respectively, during 5.7 years (IQR 5.6-5.7) of follow-up. Lowest (Q1) and highest quartile (Q4) of TyG-BMI and TyG-WC were associated with total all-cause mortality (second quartile [Q2]: reference; TyG-BMI: Q1: aHR 1.33, 95% CI 1.07-1.65, Q4: aHR 1.28, 95% CI 1.03-1.58; TyG-WC: Q1: aHR 1.44, 95% CI 1.14-1.82, Q4: aHR 1.29, 95% CI 1.04-1.59), similar results for premature all-cause mortality. Within age 45-80 years, compared with Q2 and third quartile, YLL were 4.49 and 5.46 years for TyG-BMI Q1 and Q4, respectively, 3.24 and 5.31 years for TyG-WC Q1 and Q4, respectively. TyG-BMI and TyG-WC demonstrated a U-shaped association with total and premature all-cause mortality. Low and high levels of TyG-BMI and TyG-WC were associated with reduced life expectancy. Despite the relatively short follow-up period, significant associations were still observed, but longer follow-up studies are required to further explore these relationships. Polish Lipid Association, College of Family Physician in Poland, Valeant in Poland.

Prevalence and Mortality Trends of Hypertension Subtypes Among US Adults: An Analysis of the National Health and Nutrition Examination Survey (NHANES).

Hypertension (HTN) has been demonstrated as one of the leading risk factors for development of cardiovascular disease (CVD) and CVD mortality. This study examines the prevalence and distribution of HTN subtypes (isolated diastolic hypertension [IDH], isolated systolic hypertension [ISH], and systolic-diastolic hypertension [SDH]) across age, sex, and race/ethnicity per the nationally representative National Health and Nutrition Examination Survey (NHANES) from 1999 to 2020 based on the updated 2017 ACC/AHA HTN definition. We further examined for associations of each subtype with CVD and all-cause mortality using Cox regression analysis. Among US adults, the overall prevalence of HTN is 47.4%. Across increasing age, the prevalence of IDH decreased, ISH increased, and SDH increased and peaked in the 6th decade of life after which SDH prevalence decreased. By age 80, over 80% of persons with HTN demonstrated ISH. A sub-cohort from NHANES 1999-2008 with follow-up until 2018 showed that ISH and SDH were most strongly associated with increased risk for CVD (HR 1.18, 95% CI 1.01-1.38; HR 1.31, 95% CI 1.07-1.60, respectively) and all-cause mortality (HR 1.17, 95% CI 1.06-1.28; HR 1.21, 95% CI 1.08-1.37, respectively). Our data demonstrate the continuing importance of HTN subtype transitions across age and their differences in predicting future CVD and total mortality.

Regional variation in trajectories of colon cancer mortality, 2012-2021.

41 Background: Colorectal cancer (CRC) is the fourth most common cancer by incidence in the United States in 2024, and the second most common cause of cancer mortality in Texas. Rates of advanced CRC at diagnosis and cancer related mortality are higher in rural areas. Here we explore the variation in mortality trends across the eleven public health regions (PHR) of Texas from 2012 to 2021. Methods: We conducted a population-based cohort study of colon cancer mortality in Texas over the period 2012 through 2021. We queried the National Cancer Institute Surveillance, Epidemiology and End Results Program (SEER) for county level colon cancer deaths in Texas over the most recent available decade. Counties were aggregated into the eleven public health regions defined by the Texas Department of State Health Services. We calculated age-adjusted mortality rates (AAMRs) per 100,000 population using the direct standardization method based on the age group weights from the 2000 standard US population. Confidence intervals for AAMR were derived by estimating the standard error as the AAMR divided by square root of number of mortalities. The annual percent changes (APC) in AAMR were tested using negative binomial regression. Subgroup analyses included age group, sex, and race/ethnicity. Results: A total of 33,591 colon cancer mortalities were included in the study. Total colon cancer mortalities rose from 2,973 in 2012 to 3,800 in 2021. The statewide AAMR was initially 12.4 (95% CI 12.0 to 12.9), and did not change over the study period (APC -0.1% [95% CI -0.5% to 0.2%]; p = 0.5155) ending at (AAMR 12.5 [95% CI 12.1 to 12.9]). Divergent trajectories for AAMR across public health regions were observed. The largest decline in AAMR (APC -3.9% [95% CI -6.3 to -1.6]; p = 0.0013) occurred in region 10, where the AAMR fell from 14.2% [95% CI 8.6 to 19.7]) to AAMR 11.0 [95% CI 6.8 to 15.1]. Region 6 also saw a significant decrease (APC -1.1% [95% CI -1.8% to -0.4%]; p = 0.0029) falling from AAMR 12.2 [95% CI 11.3 to 13.2] to AAMR 11.2 [95% CI 10.4 to 11.9]. The largest significant increasing trend (APC +2.3% [95% CI 0.6% to 4.1%]; p = 0.0089) for AAMR was observed for region 9 rising from AAMR 12.4 (95% CI 9.6 to 15.3) to AAMR 15.4 (95% CI 12.3 to 18.4). Conclusions: Our analysis showed a significant and increasing trend in CRC related mortality in PHR 9. This region, colloquially termed West Texas, consists of 30 counties of which over 86% are designated as rural. Rural areas struggle with higher poverty, lower degree of higher education attainment, less access to healthcare and physicians, and a higher frequency of uninsured status. West Texas in particular also has a higher rate of smoking and obesity. However, PHR 10, which shares many similarities with PHR 9 such as rurality (83.3%) and similar socioeconomic and geographic challenges, witnessed the greatest decline in AAMR of the eleven PHR's in the same time frame, suggesting the presence of other factors which may be contributing to this increase.

Circulating fatty acid profiles impact total, cardiovascular disease, and cancer mortality in a population-based prospective cohort study

Circulating fatty acid profiles impact total, cardiovascular disease, and cancer mortality in a population-based prospective cohort study

Impact of obesity on the severity, outcome and complications of acute pancreatitis

The OBJECTIVE was to study the effect of obesity on the severity of acute pancreatitis (AP), its outcome and complications.METHODS AND MATERIALS. The study included 212 patients with AP. Among the patients, 58 % (n=123) were men, and 42 % (n=89) were women. The severity of AP was mild in 63.2 %, moderate in 21.7 % and severe (SAP) in 15.1 % of cases. The average age of the patients was 52 years. Organ failure (both transient and persistent) was present in 20.3 % of all cases of AP, in 52.3 % of patients with moderate AP and in 59.4 % with SAP. The total mortality rate was 6.6 %, with mild and moderate AP, no deaths were noted, whereas with severe AP, the mortality rate was 43.8 %. The method of calculating body mass index (BMI) was used to diagnose obesity. The presence of obesity was noted at BMI of≥30 kg/m2. The number of obese patients was 39.6 % of all patients with AP. The Mann – Whitney U-test was used to compare patient groups. The criterion χ2 was used to compare the proportions of patients in different groups.RESULTS. When studying the average BMI and the proportion of obese patients, there were no significant differences in their values depending on the severity of AP. There were also no significant differences in the value of the average BMI and the proportion of obese patients in survivors and deceased patients with AP, as well as in survivors and deceased patients with SAP. Whereas, the surviving patients showed significant differences in the value of the average BMI and in the proportion of obese patients. There were no significant differences in the values of the average BMI and the proportion of obese patients in the groups of patients with OP without and with complications.CONCLUSION. Obesity does not significantly influence on the severity and frequency of complications in patients with AP.

P-2068. Assessing New York City’s COVID-19 Vaccine Rollout Strategy: A Case for Risk-Informed Distribution

Abstract Background This study reviews the impact of eligibility policies in the early rollout of the COVID-19 vaccine on coverage and probable outcomes, with a focus on New York City (NYC). Methods A retrospective ecological study was conducted assessing age 65+, area-level income, vaccination coverage, and COVID-19 mortality rates, using linked Census Bureau data and NYC Health administrative data aggregated at the level of modified zip code tabulation areas (MODZCTA). The population for this study was all individuals in 177 MODZCTA in NYC. Population data were obtained from Census Bureau and NYC Health administrative data. The total mortality rate was examined through an ordinary least squares (OLS) regression model, using area-level wealth, the proportion of the population aged 65 and above, and the vaccination rate among this age group as predictors. Results Low-income areas with high proportions of older people demonstrated lower coverage rates (mean vaccination rate 52.8%; maximum coverage 67.9%) than wealthier areas (mean vaccination rate 74.6%; maximum coverage 99% in the wealthiest quintile) in the first 3 months of vaccine rollout and higher mortality over the year. Despite vaccine shortages, many younger people accessed vaccines ahead of schedule, particularly in high-income areas (mean coverage rate 60% among those 45–64 years in the wealthiest quintile). Conclusion A vaccine program that prioritized those at greatest risk of COVID-19-associated morbidity and mortality would have prevented more deaths than the strategy that was implemented. When rolling out a new vaccine, policymakers must account for local contexts and conditions of high-risk population groups. If New York had focused limited vaccine supply on low-income areas with high proportions of residents 65 or older, overall mortality might have been lower. Disclosures All Authors: No reported disclosures

Straining to predict mortality in low flow low gradient aortic stenosis patients undergoing TAVR: can GLS and myocardial work parameters improve outcomes?

Abstract Background Classic low flow low gradient aortic stenosis (LFLG-AS) represents 5-10% of the Aortic Stenosis (AS) population and is associated with poorer clinical outcomes when compared to other AS subtypes. The survival rate of these patients is low (40–60% at 2-yrs) with conservative management. The TOPAS study found a transfemoral Transcatheter Aortic Valve Replacement (TAVR) adjusted hazard ratio (HR) of 0.23 and Surgical Aortic Valve Repair adjusted HR of 0.36. However, mortality within 2-yrs of TAVR can still be as high as 30%-50%. Currently there are no pre-TAVR echocardiographic markers that reliably predict post-TAVR outcomes. Global longitudinal strain (GLS), a load-dependent measurement, in conjunction with the recently emerging load-independent measurements, global myocardial work index (GWI) and global myocardial work efficiency (GWE), have the potential to improve peri-procedural risk stratification. Purpose This study sought to establish the sensitivity and specificity of using GLS, GWI, GWE, Contractile Reserve, and Left Ventricle Ejection Fraction (LVEF) in predicting mortality for LFLG AS patients undergoing TAVR. Methods We measured baseline GLS, GWI, GWE, Contractile Reserve, and LVEF, using GE Echo Pac AFI software (ver. 203) in patients with LFLG AS (n=29, age 79 ± 8 yrs, 69% males) that underwent low dose Dobutamine Stress Echocardiography (DSE) pre-TAVR (2017 to 2023). Contractile flow reserve (defined as &amp;gt;20% increase in LV stroke volume (SV) during DSE was recorded. LVEF was re-measured by a single operator. Receiver operating curves (ROC) were created to predict mortality using SPSS. Results Baseline LVEF was 37.6 ± 9.3% with mean AV gradient of 30 ± 10 mmHg prior to TAVR. 59% (17) had contractile reserve (25 ± 19% increase in SV). There was -0.3 ± 15.7% change in LVEF and 24% (10) patients had ≥10% improvement in LVEF at 1-yr Total mortality was 21% (6) and heart failure admission was 34% (10) at 1-yr Post TAVR, GLS (AUC 0.82, p=0.017), GWI (AUC 0.688, p=0.209) and GWE (AUC 0.82, p=0.001) can predict 1-yr mortality compared to baseline LVEF (AUC 0.536, p=0.83), and contractile reserve (AUC 0.551, p=0.132) (Figure 1). Baseline GLS of ≥ -7.5% (83% sensitivity, 83% specificity), GWI ≤ 817 mmHg% (83% sensitivity, 67% specificity) and GWE ≤74% (83% sensitivity, 67% specificity) can predict 1-yr mortality. Conclusion This study demonstrates that GLS, GWI, and GWE possess superior predictive capabilities for predicting mortality within 1-yr post-TAVR compared to baseline LVEF and contractile reserve. A baseline GLS of ≥ -7.5%, GWI ≤ 817 mmHg%, and GWE ≤ 74% were identified as thresholds with high sensitivity and specificity. This study has notable limitations, being a single-center retrospective study with a small sample size, however, the findings justify replication of this study in a larger, multicenter cohort, in an effort to improve risk stratification in the patients with LFLG-AS being considered for TAVR.

P-1778. Factors Underlying Infection-Related Mortality: Learnings from an Academic Institution with Antimicrobial Stewardship Practices

Abstract Background Limited research has explored the efficacy of Antimicrobial Stewardship (AMS) interventions in reducing Infection-Related Mortality (IRM). This study aims to evaluate the impact of AMS practices on IRM and its associated factors. Methods A retrospective case-cohort study was conducted on inpatients who expired during hospitalization between May 1, 2022, and April 30, 2023, in a tertiary hospital. The case group comprised patients with infection-related mortalities, defined as deaths caused by any potential life-threatening infection, such as sepsis, pneumonia, infective endocarditis, peritonitis, encephalitis, abscesses, meningitis, empyema, pyelonephritis, and cholecystitis. Patients who expired without such infections constituted the control group. The primary exposure variable was adherence to AMS practices during the hospital stay. A Binomial Logistic Regression model was employed to identify risk factors (e.g., age, sex, recent multi-drug-resistant organism culture positivity) for infection-related mortality in both AMS-adherent and non-adherent groups. Results Among the 1225 total mortalities, 41.3% (=506) represents the case group. It was found that only recent multi-drug resistant organism culture positivity has a significant association with AMS adherence (odds ratio =0.328 &amp; p =0.003). The statistical modeling of both groups depicted in figure 1&amp;2. Conclusion Despite adherence to AMS practices, the presence of multi-drug-resistant organism culture positivity predisposes individuals to infection-related mortality. Disclosures All Authors: No reported disclosures

The double-edged sword of statins in intracerebral hemorrhage patients: a systematic review and meta-analysis

BackgroundThis meta-analysis aimed to investigate the effect of statins on the prognosis of patients with intracerebral hemorrhage (ICH).MethodsWe conducted a systematic search using the keywords “statin” and “intracerebral hemorrhage” across four electronic databases (PubMed, Cochrane Library, Web of Science, and Embase) from their inception to October 31, 2023, to identify studies comparing the effects of statins on the prognosis of patients with ICH. The primary outcome was total mortality after ICH. This meta-analysis was registered online (PROSPERO ID: CRD42023493063).ResultsOur initial search identified 5,543 studies. After applying inclusion criteria, 30 studies with a total of 42,298 patients were included in the final analysis. Our meta-analysis showed that statins significantly reduced overall mortality in patients with ICH (OR: 0.61; 95% CI: 0.51–0.73; I2 = 87%; p &amp;lt; 0.01). Subgroup analyses further demonstrated lower mortality in ICH patients treated with statins compared to those not treated, including in the propensity score matching (PSM) group (OR: 0.59; 95% CI: 0.48–0.74; I2 = 90%; p &amp;lt; 0.01), the prospective cohort study (PCS) group (OR: 0.56; 95% CI: 0.40–0.77; I2 = 89%, p &amp;lt; 0.01), and the retrospective cohort study (RCS) group (OR: 0.64; 95% CI: 0.51–0.81; I2 = 87%, p &amp;lt; 0.01).ConclusionOur meta-analysis of 30 studies suggests that statin use may be associated with improved mortality and functional outcomes in patients with intracerebral hemorrhage (ICH).Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, CRD42023493063.

Population Dynamic of the Shield-head Catfish Synodontis Schall (Bloch &amp; Schneider, 1801) in Upper Atbara and Setit Dam Complex, Sudan

This study aimed to assess important population bio-parameters of Synodontis schall in the Upper Atbara and the Setit dam complex (Sudan), comprising asymptotic length, growth curvature, length at maturity, optimum length, growth performance index, and mortality rate. The study was based on the need to assess capture fisheries; whose success depends on understanding the species' population structure. For five months (September 2019 and January 2020), 500 specimens of S. schall were collected randomly using gillnet from fishermen monthly. Morphometric parameters were taken in the field. The length-weight relationship demonstrated a strong correlation coefficient of r = 0.902, indicating a negative allometric growth pattern with a b-value of 2.619. The von Bertalanffy growth function was used in estimating population parameters obtained from length-frequency data; The asymptotic length (L∞) was 36.75 cm, the growth curvature (K) was 0.78 yr.-1, and the optimum length (Lopt) was 23.09 cm. The total mortality (Z) was 2.09 yr.-1; exploitation rate (E) = 0.34 yr. -1, natural mortality (M) and fishing mortality (F) = 1.39 and 0.7 yr. -1, respectively. The overall growth performance index of 3.023 indicated a slow rate of growth. The results suggest that this species and other commercial species require further research on population dynamics.

Disease burden of influenza in Spain: A five-season study (2015–2020)

ABSTRACT Influenza accounts for 30% of the total morbidity and mortality in the European Union. However, the specific burden in different European countries is largely unknown, and more research is needed to ascertain the reality of this disease. In this retrospective study, we analyzed the burdens of hospitalization, intensive care unit (ICU) admission and in-hospital mortality in Spain over five seasons (2015–2020) via publicly available Minimum Basic Datasets (MDBS). The data revealed that influenza had a major impact in Spain, with approximately 29,000 hospitalizations, 2,200 ICU admissions, and 1,600 deaths each season. In this period, approximately 7.8% of those hospitalized required ICU admission, and 5.7% died in the hospital due to influenza, with wide differences in these parameters depending on the season due to the virological characteristics of the major circulating viruses. More than 60% of those hospitalized were over 65 years of age, and approximately 82% of those who died were elderly, demonstrating that the greatest burden of hospitalization and mortality is centered on this age group. The annual direct cost of influenza was approximately €128 million per season, with more than 80% of this cost centered on people over 45 years of age.

The association between obesity indicators and mortality among individuals with hyperlipidemia: evidence from the NHANES 2003–2018

BackgroundObesity is linked to a variety of metabolic issues, with hyperlipidemia being a crucial adjustable risk element for cardiovascular diseases (CVD). However, the connection between indicators of obesity with overall and CVD mortality in American adults with hyperlipidemia remains unknown.MethodsThis research employed an extensive cohort drawn from the National Health and Nutrition Examination Survey (NHANES) (2003–2018). Hyperlipidemia was identified through either elevated lipid profiles or self-reported utilization of lipid-reducing medications. Obesity indicators (weight-adjusted waist index (WWI), waist-to-height ratio (WHtR), body mass index (BMI)) were evaluated by physical measurement data. Weighted Cox regression models and restricted cubic splines (RCS) were employed to assess the potential links between obesity indicators and mortality outcomes. Results were further validated through subgroup analyses to ensure robustness and reliability. The receiver operating characteristic (ROC) curve was utilized to evaluate the prognostic capability of obesity indicators for mortality.ResultsThis cohort study included data from 12,785 participants with hyperlipidemia. Over an average follow-up period of 8.4 years, a total of 1,454 deaths were documented, 380 of which were related to heart diseases. Cox analysis manifested that, after adjusting covariates, increased WWI was linked to a higher likelihood of overall and CVD mortality (both P < 0.05). RCS analysis illustrated that BMI and WHtR had U-shaped relationships with the overall and CVD mortality. Conversely, a linear positive association was uncovered between WWI and mortality (both P > 0.05 for nonlinearity). Age, alcohol consumption and chronic kidney disease had modifying effects on the relationship between WWI and total mortality among those with hyperlipidemia. The area under ROC indicated that WWI was more effective than for BMI and WHtR in predicting overall and CVD deaths.ConclusionsIn US adults with hyperlipidemia, the connection between BMI, WHtR, with overall and CVD mortality followed a U-shaped pattern, whereas a positive linear correlation was identified between WWI and mortality. WWI has superior predictive capability for the prognosis of individuals with hyperlipidemia compared to BMI and WHtR. These findings provide new insights and targets for the health management of individuals affected by hyperlipidemia.

Blunt Traumatic Aortic Injury Treated with Endovascular Aortic Repair: Does Age Influence the Outcome?

Background: Blunt traumatic aortic injury (BTAI) is the second most common cause of death following blunt trauma, and it can affect people of all ages. The aim of this study was to evaluate age-related differences in outcomes among patients undergoing thoracic endovascular aortic repair (TEVAR) for BTAI. Methods: All patients treated with TEVAR for BTAI at a tertiary care center in Europe between 2005 and 2023 were included in this study. All clinical and imaging data were collected and analyzed retrospectively. Results: A total of 70 patients with a median age of 43 years were included, and 89% were male. Older patients had significantly higher American Society of Anesthesiologists (ASA) physical status classification scores (p &lt; 0.001) compared to younger patients. All age groups (&lt;18, 18–40, 41–65, and &gt;65) exhibited low to borderline low initial hemoglobin levels with a further decline over time (p = 0.063, p &lt; 0.001, p &lt; 0.001, and p = 0.018, respectively). Age groups were comparable regarding injury mechanism, Injury Severity Score (ISS), concomitant injuries and postoperative complications. The age-independent ISS showed a moderate to strong correlation to the length of intensive care unit stay (r = 0.594, p &lt; 0.001). Total in-hospital mortality was 6% and none was from aortic-related complications. There was a generally high rate of loss of follow-up (59%). Conclusions: Although older patients presented worse ASA scores in comparison to younger patients, no significant differences regarding postoperative morbidity/mortality were noted. These findings imply that patient age and preinjury physical status might not substantially influence outcomes when treating BTAI with TEVAR.

Estimating mortality attributable to alcohol or tobacco – a cohort study from Germany

BackgroundLittle is known about mortality from four disorder combinations: fully attributable to alcohol or tobacco, partly attributable to both alcohol and tobacco, to tobacco only, to alcohol only.AimTo analyze whether residents who had disclosed risky alcohol drinking or daily tobacco smoking had a shorter time to death than non-risky drinkers and never daily smokers twenty years later according to the disorder combinations.MethodsA random adult general population sample (4,075 study participants) of a northern German area had been interviewed in the years 1996–1997. Vital status and death certificate data were gathered 2017–2018. The data analysis included estimates of alcohol- or tobacco-attributable mortality using all conditions given in the death certificate and alternatively the underlying cause of death only.ResultsAmong 573 deaths, 71.9–94.1% had any alcohol- or tobacco-attributable disorder depending on the estimate. Risky alcohol consumption and daily tobacco smoking at baseline were related to disorders in the death certificate according to the combinations. Deaths with an alcohol- and tobacco-attributable disorder were related to risky alcohol consumption (subhazard ratio 1.57; 95% confidence interval 1.25–1.98) and to daily tobacco smoking at baseline (subhazard ratio 1.85; 95% confidence interval 1.42–2.41).ConclusionFirst, more than 70% of the deceased persons had one or more alcohol- or tobacco-attributable disorders. This finding suggests that total mortality seems to be the suitable outcome if potential effects of alcohol or tobacco consumption in a general population are to be estimated. Second, the relations of risky alcohol consumption and tobacco smoking with time to death speak in favor of the validity of alcohol- and of tobacco-attributable disorders in death certificates and of considering both alcohol consumption and tobacco smoking if attributable deaths are to be estimated.