Abstract 19627: A National Perspective of the Influence of Do-Not-Resuscitate Orders on In-Hospital Mortality and Adverse Outcome after Intracerebral Hemorrhage

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Achint Patel ◽  
Sopan Lahewala ◽  
Neil Patel ◽  
Girish N Nadkarni ◽  
Grishma Dhaduk ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Hospital Mortality ◽  
Adverse Outcome ◽  
Adverse Outcomes ◽  
Categorical Variables ◽  
Do Not Resuscitate ◽  
Multilevel Regression ◽  
Co Morbidity ◽  
The Impact ◽  
Dnr Orders

Background: The impact of do-not-resuscitate (DNR) orders on outcomes has not been systematically evaluated in Intracerebral Hemorrhage (ICH). Hypothesis: We assessed the impact of DNR orders in ICH and its association to mortality/related adverse outcomes. Methods: We reviewed the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample(NIS) database of 2011 for ICH using ICD 9-CM codes(431).This represents 20% of all US hospital patients and weighted numbers represent national estimates. We defined patients’ DNR status with ICD code V49.86 and comorbid conditions by Deyo’s modification of Charlson’s Comorbidity Index (CCI). We only included adult patients in our analysis. Our primary outcomes of interest were in-hospital mortality and adverse outcome (composite of mortality & discharge other than home). We utilized chi-square test for univariable analysis for categorical variables and generated hierarchical multilevel regression models to determine independent predictors of mortality and adverse outcome. Results: We analyzed a total of 13440 pts (weighted n= 64617) with ICH of which 2029 (weighted n=9713) patients had DNR status. The proportions of mortality (56% vs. 19%, p<0.001) and adverse outcome(89% vs 70%) were higher in patients with DNR orders. Even after adjusting for confounders (demographics, Deyo’s modification of charlson’s co-morbidity index, admission type (elective vs emergent), hospital region, hospital teaching status, hospital ICH volume and primary payer), DNR status was associated with higher in hospital mortality (OR 6.98, 95% CI 6.58-7.41), p<0.001) and higher odds of adverse outcome (OR 3.98, 95% CI 3.64-4.34, p<0.001). Conclusion: DNR status in patients admitted with ICH appears to be a independent and significant predictor of substantially increased hospital mortality and adverse outcomes. The reasons for this are multifactorial and likely involve patient as well as systematic factors.Further studies including both quantitative/qualitative aspects are warranted to investigate these factors in detail.

Abstract 19854: A National Perspective of Weekend- Effect on Mortality and Adverse Outcomes in Patients with Intracerebral Hemorrhage

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Achint Patel ◽  
Girish Nadkarni ◽  
Neil Patel ◽  
Sopan Lahewala ◽  
Sudharani Busani ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Hospital Mortality ◽  
Adverse Outcome ◽  
Adverse Outcomes ◽  
Weekend Effect ◽  
Categorical Variables ◽  
Multilevel Regression ◽  
Chi Square ◽  
Co Morbidity ◽  
Morbidity Index

Introduction: Management of intracerebral hemorrhage (ICH) requires urgent diagnostic and therapeutic procedures, which may not be uniformly available throughout the week. We attempt to define a "weekend effect" for ICH, which has not yet been fully established in this patient population. Hypothesis: We aimed to evaluate whether outcomes differ with respect to the day of admission in patients admitted with ICH. Methods: We reviewed the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample (NIS) database from 2000 to 2011 for ICH using ICD 9-CM codes. NIS represents 20% of all US hospital pts and weighted numbers represent national estimates.We defined primary outcome as mortality and adverse outcome(composite of in-hospital mortality & discharge other than home). We utilized chi-square test for univariable analysis for categorical variables and generated hierarchical multilevel regression models to determine independent predictors of mortality and adverse outcome. Results: We included 161017 patients (weighted n=788641) with ICH, out of which 42996(weighted n= 210592) were admitted on weekend. After adjusting for confounders (demographics, Deyo’s modification of charlson’s co-morbidity index, admission type (elective or emergent), hospital region, hospital teaching status, hospital ICH volume and primary payer), the weekend admissions were still associated with 10 % higher mortality (OR 1.10, 95% CI 1.07-1.16, P=0.001) and 20% higher adverse outcome (OR 1.12, 95% CI 1.09-1.16, p=0.001). Conclusions: Thus, admission for ICH on the weekend was a significant and independent predictor of increased in hospital mortality and adverse outcomes as compared to weekday admission. The reasons for this are likely manifold and warrant further investigation both from a quantitative and qualitative standpoint.

scholarly journals Neutrophil-to-Lymphocyte Ratio Is an Independent Predictor for In-Hospital Mortality in Spontaneous Intracerebral Hemorrhage

2017 ◽  
Vol 44 (1-2) ◽  
pp. 26-34 ◽  
Author(s):  
Antje Giede-Jeppe ◽  
Tobias Bobinger ◽  
Stefan T. Gerner ◽  
Jochen A. Sembill ◽  
Maximilian I. Sprügel ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Hospital Mortality ◽  
Functional Outcome ◽  
Neurological Status ◽  
Infectious Complications ◽  
Adverse Outcomes ◽  
Neutrophil To Lymphocyte Ratio ◽  
Close Monitoring ◽  
Lymphocyte Ratio ◽  
The Impact

Background and Purpose: Stroke-associated immunosuppression and inflammation are increasingly recognized as factors that trigger infections and thus, potentially influence the outcome after stroke. Several studies demonstrated that elevated neutrophil-to-lymphocyte ratio (NLR) is a significant predictor of adverse outcomes in patients with ischemic stroke. However, little is known about the impact of NLR on short-term mortality in intracerebral hemorrhage (ICH). Methods: This observational study included 855 consecutive ICH-patients. Patient demographics, clinical, laboratory, and in-hospital measures as well as neuroradiological data were retrieved from institutional databases. Functional 3-months-outcome was assessed and categorized as favorable (modified Rankin Scale [mRS] 0-3) and unfavorable (mRS 4-6). We (i) studied the natural course of NLR in ICH, (ii) analyzed parameters associated with NLR on admission (NLROA), and (iii) evaluated the clinical impact of NLR on mortality and functional outcome. Results: The median NLROA of the entire cohort was 4.66 and it remained stable during the entire hospital stay. Patients with NLR ≥4.66 showed significant associations with poorer neurological status (National Institute of Health Stroke Scale [NIHSS] 18 [9-32] vs. 10 [4-21]; p < 0.001), larger hematoma volume on admission (17.6 [6.9-47.7] vs. 10.6 [3.8-31.7] mL; p = 0.001), and more frequently unfavorable outcome (mRS 4-6 at 3 months: 317/427 [74.2%] vs. 275/428 [64.3%]; p = 0.002). Patients with an NLR under the 25th percentile (NLR <2.606) - compared to patients with NLR >2.606 - presented with a better clinical status (NIHSS 12 [5-21] vs. 15 [6-28]; p = 0.005), lower hematoma volumes on admission (10.6 [3.6-30.1] vs. 15.1 [5.7-42.3] mL; p = 0.004) and showed a better functional outcome (3 months mRS 0-3: 82/214 [38.3%] vs. 185/641 [28.9%]; p = 0.009). Patients associated with high NLR (≥8.508 = above 75th-percentile) showed the worst neurological status on admission (NIHSS 21 [12-32] vs. 12 [5-23]; p < 0.001), larger hematoma volumes (21.0 [8.6-48.8] vs. 12.2 [4.1-34.9] mL; p < 0.001), and higher proportions of unfavorable functional outcome at 3 months (mRS 4-6: 173/214 vs. 418/641; p < 0.001). Further, NLR was linked to more frequently occurring infectious complications (pneumonia 107/214 vs. 240/641; p = 0.001, sepsis: 78/214 vs. 116/641; p < 0.001), and increased c-reactive-protein levels on admission (p < 0.001; R2 = 0.064). Adjusting for the above-mentioned baseline confounders, multivariable logistic analyses revealed independent associations of NLROA with in-hospital mortality (OR 0.967, 95% CI 0.939-0.997; p = 0.029). Conclusions: NLR represents an independent parameter associated with increased mortality in ICH patients. Stroke physicians should focus intensely on patients with increased NLR, as these patients appear to represent a population at risk for infectious complications and increased short-mortality. Whether these patients with elevated NLR may benefit from a close monitoring and specially designed therapies should be investigated in future studies.

scholarly journals Burden of arrhythmia in hospitalized patients with cannabis use related disorders: analysis of 2016-2018 national inpatient sample

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
H Thyagaturu ◽  
S Thangjui ◽  
B Shrestha ◽  
K Shah ◽  
R Naik ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Cardiac Arrhythmia ◽  
Case Reports ◽  
Cannabis Use ◽  
Categorical Variables ◽  
Cannabis Use Disorder ◽  
National Inpatient Sample ◽  
Income Status ◽  
Co Morbidity ◽  
Study Results

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cannabis is being more widely use as a recreational substance worldwide. There have been case reports and systematic review describing the association of cannabis use and cardiac arrhythmia (1). Purpose We sought out to measure the prevalence of different types of cardiac arrhythmia in hospitalizations associated with cannabis use disorder. Methods We queried January 2016 to December 2018 National Inpatient Sample (NIS) databases to identify adult (≥18 yrs) hospitalizations in the US with a diagnosis of cannabis use related disorders. Patients with an associated diagnosis of arrhythmias were also identified based on appropriate ICD-10 CM codes. We used the Chi-square test to evaluate the differences between binary or categorical variables, and Student’s t-test for continuous variables. Multivariate logistic regression was used in outcomes analysis to adjust for potential hospital and patient-level confounders (age, sex, race, diabetes, heart failure, chronic kidney disease, anemia, obesity, elixhauser co-morbidity index, hospital location, teaching status, bed size, income status and others). The discharge weights provided in the databases were used to calculate the national estimates. STATA 16.1 software was used to perform all statistical analysis. Results We identified 2,457,544 hospitalizations associated with cannabis use related disorders across three years. Of which, 187,825 (7.6%) were associated with any arrhythmia. We found that atrial fibrillation was the most associated arrhythmia. The complete list of types of arrhythmia and their prevalence are described in Figure-1. Patients with arrhythmia group were older (mean age 50.5 vs 38.3 yrs; P &lt; 0.01) and had higher co-morbidity (% of &gt;3 Elixhauser comorbidity score 94.1% vs 60.6%; P &lt; 0.01). After adjusting for patient and hospital-level confounders, we observed arrhythmia group was associated with higher odds of in-hospital mortality compared to the group without arrhythmia [Odds Ratio (OR): 4.5 (4.09 – 5.00); P &lt; 0.01]. We also observed statistically significant increase in hospitalization length of stay due to the status of any arrhythmia [5.7 vs 5.1 days; P &lt; 0.01]. Conclusion The prevalence of Afib is high in hospitalizations associated with cannabis use. Hospitalizations associated with cannabis use disorder and any arrhythmia are associated with higher in-hospital mortality and LOS. Therefore, all electrocardiograms should be scrutinized in hospitalized cannabis users. However, further prospective studies are necessary to endorse our study results. Abstract Figure.

Does obesity affect the short-term outcomes after cardiothoracic surgery in adolescents with congenital heart disease?

2020 ◽  
Vol 30 (3) ◽  
pp. 372-376 ◽  
Author(s):  
Richard U. Garcia ◽  
Preetha L. Balakrishnan ◽  
Sanjeev Aggarwal
Keyword(s):  
Body Mass Index ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Body Mass ◽  
Congenital Heart ◽  
Adverse Outcome ◽  
Normal Weight ◽  
Adverse Outcomes ◽  
Short Term ◽  
The Impact

AbstractBackground:Obesity is a modifiable, independent risk factor for mortality and morbidity after cardiovascular surgery in adults. Our objective was to evaluate the impact of obesity on short-term outcomes in adolescents undergoing surgery for congenital heart disease (CHD).Methods:This retrospective chart review included patients 10–18 years of age who underwent CHD surgery. Our exclusion criteria were patients with a known genetic syndrome, heart transplantation, and patients with incomplete medical records. The clinical data collected included baseline demographics and multiple perioperative variables. Charting the body mass index in the Centers for Disease Control and Prevention growth curves, the entire cohort was divided into three categories: obese (>95th percentile), overweight (85th–95th percentile), and normal weight (<85th percentile). The composite outcome included survival, arrhythmias, surgical wound infection, acute neurologic injury, and acute kidney injury.Results:The study cohort (n = 149) had a mean standard deviation (SD), body mass index (BMI) of 22.6 ± 6.5 g/m2, and 65% were male. There were 27 obese (18.1%), 24 overweight (16.1%), and 98 normal weight (65.8%) patients. Twenty-seven (18%) patients had composite adverse outcomes. Overweight and obese patients had significantly higher adverse outcomes compared with normal weight patients (odds ratio (OR): 2.9; confidence interval (CI): 1–8.5, p = 0.04 and OR: 3; CI: 1–8.5, p = 0.03, respectively). In multivariate analysis, obesity was an independent predictor of adverse outcome in our cohort (p = 0.04).Conclusions:Obesity is associated with short-term adverse outcome and increased health resource utilisation in adolescents following surgery for CHD. Further studies should evaluate if intervention in the preoperative period can improve outcomes in this population.

scholarly journals Impact of Early C-Reactive Protein/Albumin Ratio on Intra-Hospital Mortality Among Patients with Spontaneous Intracerebral Hemorrhage

2020 ◽  
Vol 9 (4) ◽  
pp. 1236 ◽  
Author(s):  
Michael Bender ◽  
Kristin Haferkorn ◽  
Michaela Friedrich ◽  
Eberhard Uhl ◽  
Marco Stein
Keyword(s):  
Regression Analysis ◽  
Intracerebral Hemorrhage ◽  
Hospital Mortality ◽  
Cox Regression ◽  
Spontaneous Intracerebral Hemorrhage ◽  
C Reactive Protein ◽  
Albumin Ratio ◽  
Cox Regression Analysis ◽  
Reactive Protein ◽  
The Impact

Objective: The impact of increased C-reactive protein (CRP)/albumin ratio on intra-hospital mortality has been investigated among patients admitted to general intensive care units (ICU). However, it was not investigated among patients with spontaneous intracerebral hemorrhage (ICH). This study aimed to investigate the impact of CRP/albumin ratio on intra-hospital mortality in patients with ICH. Patients and Methods: This retrospective study was conducted on 379 ICH patients admitted between 02/2008 and 12/2017. Blood samples were drawn upon admission and the patients’ demographic, medical, and radiological data were collected. The identification of the independent prognostic factors for intra-hospital mortality was calculated using binary logistic regression and COX regression analysis. Results: Multivariate regression analysis shows that higher CRP/albumin ratio (odds ratio (OR) = 1.66, 95% confidence interval (CI) = 1.193–2.317, p = 0.003) upon admission is an independent predictor of intra-hospital mortality. Multivariate Cox regression analysis indicated that an increase of 1 in the CRP/albumin ratio was associated with a 15.3% increase in the risk of intra-hospital mortality (hazard ratio = 1.153, 95% CI = 1.005–1.322, p = 0.42). Furthermore, a CRP/albumin ratio cut-off value greater than 1.22 was associated with increased intra-hospital mortality (Youden’s Index = 0.19, sensitivity = 28.8, specificity = 89.9, p = 0.007). Conclusions: A CRP/albumin ratio greater than 1.22 upon admission was significantly associated with intra-hospital mortality in the ICH patients.

Abstract 92: Demographic, Regional and Social Predictors of Do Not Resuscitate Order Utilization in Intracerebral Hemorrhage: A National Perspective

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Vishal B Jani ◽  
Achint Patel ◽  
Girish Nadkarni ◽  
Alexandre Benjo ◽  
Narender Annapureddy ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Private Insurance ◽  
Female Gender ◽  
P Value ◽  
Weighted Estimate ◽  
Do Not Resuscitate ◽  
Discrimination Power ◽  
Social Predictors ◽  
North East ◽  
Dnr Orders

Background: Non-traumatic Intracerebral hemorrhage (ICH) is a life-threatening condition associated with substantial morbidity and mortality. Do-not-resuscitate (DNR) orders have recently linked to poor outcomes in ICH patients probably due to the inactive management associated with these orders. Hypothesis: We tested the hypothesis that demographic, regional and social factors not related to ICH severity are significant predictors of DNR utilization. Methods: We reviewed the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (NIS) database from 2011-2012 for ICH admissions in patients >18 years using the ICD 9-CM code 431. We defined DNR status with ICD code - V49.86 entered during the same admission as a secondary diagnosis and estimated severity of illness by the 3M™ All Patient Refined DRG (APR DRG) classification System. A hierarchical two level multivariate regression model were generated to estimate odds ratios (OR) for predictors of DNR utilization and discrimination power of models was assessed using C statistics. We considered a two tailed p value of <0.01 to be significant. Results: We analyzed 25768 pts (weighted estimate 126254) with ICH out of which 4620 (18%) pts (weighted estimate 22668) had DNR orders placed. In multivariable regression analysis, female gender (OR 1.2, 95% CI 1.2-1.3), Ethnicity [White(OR 1.6, 95% CI 1.5-1.7) and Hispanic(OR 1.2, 95% CI 1.1-1.3) compared to Black], Insurance [Medicare (OR 1.1, 95% CI 1.1-1.2) and self or no pay (OR 1.1, 95% CI 1.0-1.2) compared to private insurance], Hospital location [West (OR 1.6, 95% CI 1.2-2.1) compared to North-East ] were significantly associated with high DNR utilization rates after adjusting for patient level, hospital level characteristics, APR DRG severity scale and other clinical characteristics. Conclusions: In conclusion, demographic (female gender/ethnicity), social (insurance status) and regional (hospital location) are significantly associated with increased DNR utilization. The reasons for this are likely multifactorial, qualitative, linked to both patient and provider practices and need to be explored in more detail.

Abstract TP334: Clinical Impact of Hematoma Expansion in LVAD Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Kara Melmed ◽  
David Roh ◽  
Josh Willey
Keyword(s):  
Hospital Mortality ◽  
Medical Center ◽  
Demographic Data ◽  
Similar Rate ◽  
Left Ventricular ◽  
Hematoma Expansion ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Ich Score ◽  
The Impact

Background: Intracerebral hemorrhage (ICH) in left ventricular assist device (LVAD) patients is a devastating complication. Hematoma expansion (HE) is associated with poor outcomes in ICH patients, but the impact of HE on LVAD patients is not known. Prevention of HE includes rapid and complete coagulopathy reversal, adding further potential complications in LVAD patients given the inherent risk of hardware thrombosis. We aimed to define the occurrence of HE in the LVAD population and to determine the association between HE and mortality in this population. Methods: We performed a retrospective cohort study of ICH patients with preceding LVAD implantation admitted to Columbia University Irving Medical Center between Jan 2008 and April 2019. Intentionally matched ICH controls without LVADs were identified to compare rate of HE in LVAD and non LVAD patients. ICH volume was measured using ABC/2 method.We defined HE as an increase in hematoma volume of 6 ml or 33% comparing the first and last scan in 24 hours. Demographic data was compared using Pearson’s χ2 test for categorical variables and students T test and Wilcoxon rank sum test for normal and non-parametric continuous variables. The association between HE and hospital mortality in LVAD patients was examined using regression modeling after adjusting for Glasgow coma scale, age, hematoma size and location and admission INR. Results: Of605 LVAD patients, we identified 40 patients with ICH. Of these, 28 patients met the inclusion criteria. Mean (SD) age of LVAD patients was 56 (10), 29% of patients were female and the majority (81%) of LVAD patients were supported by Heartmate II. The median (interquartile range [IQR]) baseline hematoma size was 20.1 ml (8.6-46.9), median (IQR) ICH score was 1 (1-2). HE occurred in 16 (57%) patients supported by LVAD, and in 50% of patients without LVAD with no difference (p=0.6).There was an association between HE and in-hospital mortality in LVAD patients after adjusting for admission ICH score and INR (OR of 20.5, 95% CI: 1.8-232.8). Conclusions: HE is a potentially modifiable risk factor for mortality. We demonstrate that LVAD patients experience HE at a similar rate to matched controls. We show that prevention of HE with anticoagulation reversal does not increase mortality.

Withdrawal of Life-Sustaining Treatment Mediates Mortality in Patients With Intracerebral Hemorrhage With Impaired Consciousness

Stroke ◽  
2021 ◽  
Author(s):  
Ayham Alkhachroum ◽  
Antonio J. Bustillo ◽  
Negar Asdaghi ◽  
Erika Marulanda-Londono ◽  
Carolina M. Gutierrez ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Hospital Mortality ◽  
Odds Ratio ◽  
Mediation Effect ◽  
Hospital Length Of Stay ◽  
Do Not Resuscitate ◽  
Hospital Size ◽  
Stroke Registry ◽  
Discharge Disposition ◽  
Life Sustaining Treatment

Background and Purpose: Impaired level of consciousness (LOC) on presentation at hospital admission in patients with intracerebral hemorrhage (ICH) may affect outcomes and the decision to withhold or withdraw life-sustaining treatment (WOLST). Methods: Patients with ICH were included across 121 Florida hospitals participating in the Florida Stroke Registry from 2010 to 2019. We studied the effect of LOC on presentation on in-hospital mortality (primary outcome), WOLST, ambulation status on discharge, hospital length of stay, and discharge disposition. Results: Among 37 613 cases with ICH (mean age 71, 46% women, 61% White, 20% Black, 15% Hispanic), 12 272 (33%) had impaired LOC at onset. Compared with cases with preserved LOC, patients with impaired LOC were older (72 versus 70 years), more women (49% versus 45%), more likely to have aphasia (38% versus 16%), had greater ICH score (3 versus 1), greater risk of WOLST (41% versus 18%), and had an increased in-hospital mortality (32% versus 12%). In the multivariable-logistic regression with generalized estimating equations accounting for basic demographics, comorbidities, ICH severity, hospital size and teaching status, impaired LOC was associated with greater mortality (odds ratio, 3.7 [95% CI, 3.1–4.3], P <0.0001) and less likely discharged home or to rehab (odds ratio, 0.3 [95% CI, 0.3–0.4], P <0.0001). WOLST significantly mediated the effect of impaired LOC on mortality (mediation effect, 190 [95% CI, 152–229], P <0.0001). Early WOLST (<2 days) occurred among 51% of patients. A reduction in early WOLST was observed in patients with impaired LOC after the 2015 American Heart Association/American Stroke Association ICH guidelines recommending aggressive treatment and against early do-not-resuscitate. Conclusions: In this large multicenter stroke registry, a third of ICH cases presented with impaired LOC. Impaired LOC was associated with greater in-hospital mortality and worse disposition at discharge, largely influenced by early decision to withhold or WOLST.

Cigarette Smoking Is Associated with Adverse Outcome in Low Risk MDS Patients

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5628-5628
Author(s):  
Effie Rahman ◽  
Sarvari Venkata Yellapragada ◽  
Martha P. Mims ◽  
Kirtan Nautiyal ◽  
Manuel Molina ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
Adverse Outcome ◽  
Adverse Outcomes ◽  
Environmental Chemicals ◽  
Low Risk ◽  
Myelogenous Leukemia ◽  
Smoking History ◽  
Survival Difference ◽  
Blast Count ◽  
The Impact

Abstract Background: Low-risk myelodysplastic syndrome (LR-MDS) is a heterogeneous group of diseases characterized by dysplastic ineffective hematopoeisis and risk for acute myelogenous leukemia (AML). Despite improved risk classification, LR-MDS subgroups exhibit outcome heterogeneity. Non-hemopoeitic comorbidities highlight interaction of organ dysfunction and adverse outcomes. Previous studies have identified association between smoking and development of MDS (Du Y. Leuk Res. 2010). Among others, smoking induces DNA double strand breaks (Huang et al, 2012) and gene methylation modification leading to impaired environmental chemicals detoxification. In this study, we analyze the clinical impact of smoking and intensity of exposure on LR-MDS outcome. Methods: With prior IRB approval, 90 LR-MDS patients from the Michael E. DeBakey VA Medical Center cancer registry were analyzed between 2000-2012. Smoked pack-years (PY) was recorded according to accepted definition. PY estimate derived from Framingham heart study (Mannan H et al., Heart International. 2010) was used to evaluate smoking dose-dependent correlation with survival in: (1) non-smoker [NS], (2) <20, (3) >20-39, and (4) >40 PY. Univariate and multi-variable analysis evaluated the impact of potential confounding variables such as degree of cytopenia at disease initiation, blast count, karyotype, and R-IPSS score. Results: 69 (76%) and 22 (24%) pts were smokers and NS. Median age was 71 years (y) (range, 55-84) and 73 y (60-87), for smokers and NS, P=0.38. 22 (24%), 35 (38%) and 34 (37%) of pt were very low, low, and intermediate risk R-IPSS. Median hemoglobin, ANC, and platelet levels among smokers and NS were 9.4 g/dL vs 8.8 g/dL (P=0.18), 2.7 K/uL vs 3.2 K/uL (P=0.13) and 118 K/uL vs 158 K/uL (P=0.11). Median absolute R-IPSS score for smokers and NS were 0.5 (range, 0-1.5) and 0.25 (range, 0-2), P=0.40. OS in smokers vs NS was 728 vs 1877 days (d), P=0.04, 95% CI= 1.015 to 2.923 (Fig. 1). 65/71 (92%) pt contributed to analysis of cumulative effect of smoking on OS. Given the lack of significant survival difference among pt with >20-39 and >40 PY, 3 distinct subgroups were identified showing a median OS of 2117, 1020 and 717 d, for NS, <20 and >20 PY, respectively, P=0.01 (Fig. 2). Univariate and multivariate analysis revealed no impact of blast count, depth of cytopenias, karyotype, and R-IPSS on observed outcomes. Conclusions: Our study suggests a mechanistic link between smoking and adverse outcome in LR-MDS. Higher cumulative smoking exposure is potentially associated with worse OS. Larger studies involving LR-MDS pt with smoking history are necessary to confirm this association. Further research is needed to clarify underpinning mechanisms resulting in unfavorable smoking-induced LR-MDS phenotype. This could facilitate implementation of MDS directed therapy in subgroups with more aggressive outcome. Figure 1 Figure 1. Figure 2 Figure 2. Disclosures No relevant conflicts of interest to declare.

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