156: DISCHARGE OUTCOMES OF PATIENTS WITH COVID-19 ADMITTED TO THE ICU: THE VIRUS REGISTRY

Background: Hemorrhagic stroke patients may require inter-facility transfer for higher level of care. Limited data are available on outcome of transferred patients. Objective: To determine in-hospital mortality and discharge outcomes among transferred hemorrhagic stroke patients. Methods: Data from all patients admitted to US hospitals between 2008 and 2011 with a primary discharge diagnosis of hemorrhagic stroke [intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH)] were identified by ICD-9 codes (ICH: 431; SAH: 430). In separate models for ICH and SAH using logistic regression, the odds ratio (OR) and 95% confidence intervals (CI) for in-hospital mortality and good outcome (discharge home or inpatient rehabilitation) among transfer vs. non-transfers were estimated, after adjusting for potential confounders. Results: Of 290,395 patients with ICH, 48,749 (16.8%) arrived by inter-hospital transfer; for SAH, 25,726 (33%) of 78,156 were transfers. In-hospital mortality was lower among ICH transfers (21.2% vs. 23.2%; p=0.004). In adjusted analyses, in-hospital mortality was not significantly different (p=0.20) while discharge to home or inpatient rehabilitation was more likely among transferred ICH patients (OR 1.1, 95% CI 1.0-1.2, p=0.05). In-hospital mortality was lower for SAH transfers (17.4% vs. 22.9%, p<0.001) and remained significant in adjusted analyses (OR 0.7, 95% CI 0.6-0.8). Transferred SAH patients were also more likely to be discharged to home or inpatient rehabilitation (OR 1.2, 95% CI 1.1-1.4, p<0.001). Coiling and clipping procedures were significantly more common in SAH transferred patients while cerebral angiography, mechanical ventilation and gastrostomy were significantly higher in both ICH and SAH transfer patients. Conclusion: While ICH patients arriving by transfer have similar mortality as non-transfers, they are more likely to be discharged to home or acute rehabilitation. For SAH, transfer confers both mortality and outcome benefit. Definitive surgical treatments and aggressive medical supportive care at receiving hospitals may mediate the benefits of inter-hospital transfer in hemorrhagic stroke patients.

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153 Prognostic Role of the Low Tri-Iodothyronine Syndrome in Brain Tumor Patients

Neurosurgery ◽

10.1093/neuros/nyx417.153 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 237-237

Author(s):

Adomas Bunevicius ◽

Sarunas Tamasauskas ◽

Vytenis Deltuva ◽

Edward R Laws ◽

Arimantas Tamasauskas

Keyword(s):

Brain Tumor ◽

Health Status ◽

Adjuvant Treatment ◽

Extent Of Resection ◽

Histological Diagnosis ◽

Low T3 Syndrome ◽

Tumor Patients ◽

Low T3 ◽

Increased Risk ◽

Discharge Outcomes

Abstract INTRODUCTION Reduced triiodothyronine (T3) concentrations were implicated in worse prognosis of brain tumor patients. We investigated the association of thyroid hormone concentrations with health-related quality of life (HRQoL), discharge outcomes and prognosis of brain tumor patients. METHODS Two-hundred and thirty brain tumor patients (70% women) before brain tumor surgery were evaluated for HRQoL (ERTC QLQ-C30 and QLQ-BN20 questionnaires); and thyroid function profile. The Low tri-iodothyronine (T3) syndrome was defined as T3 concentration below the reference range. Unfavorable hospital discharge outcomes were determined as Glasgow outcome scale score of = 3. Follow-up continued until November, 2015. RESULTS >Seventy-four percent of patients had Low T3 syndrome. After adjusting for the brain tumor histological diagnosis, patients' age, gender and functional status, lower free T3 concentrations were associated with worse HRQOL on the QLQ-C30 Global health status (ß = 0.302, P = 0.017), Emotional functioning (ß = 0.422, p<.001) and Cognitive functioning (ß = 0.259, P = 0.042) domains, and with greater symptom severity on the QLQ-BN20 Fatigue (ß = −0.238, p = .041), Motor dysfunction (ß = −0.283, P = 0.013) and Weakness of legs (ß = −0.269. P = 0.027) domains. Preoperative Low T3 syndrome increased risk for unfavorable discharge outcomes adjusting for age, gender and histological diagnosis (OR = 2.944, 95%CI [1.314-6.597], p = .009). In all patients, lower total (p = .038) and free (p = .014) T3 concentrations were associated with greater mortality adjusting for age, gender, extent of resection, adjuvant treatment and histological diagnosis. The Low T3 syndrome was associated with greater 5-year mortality for glioma patients (HR = 2.197; 95%CI [1.160-4.163], p = .016) and with shorter survival (249 [260] vs. 352 [399] days; p = .029) of high grade glioma patients independent of age, gender, extent of resection and adjuvant treatment. CONCLUSION The Low T3 syndrome is common in brain tumor patients and is associated with worse health status, impaired emotional and physical aspects of HRQoL and worse discharge outcomes. The Low T3 syndrome is associated with shorter survival of glioma patients.

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