Abstract 15408: Risk Factors Associated With In-hospital Mortality for Cardiac Device Extraction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
James B Hammock ◽  
Chad Colon ◽  
James Barrios ◽  
Blake Smith ◽  
Vedran Oruc ◽  
...  

Introduction: Cardiac device extraction procedures are associated with increased risk of in-hospital mortality. The objective of this study was to determine risk factors for in-hospital mortality of patients undergoing cardiac device extraction. Methods: We studied patients undergoing cardiac device removal between January 2016 and December 2019 at a single tertiary care center. Baseline patient characteristics, comorbidities, and preoperative laboratory data were obtained by database query (Table 1) . The outcome of interest was in-hospital death following cardiac device extraction. Odds ratios (OR) and confidence intervals (CI) were used to measure relationships between exposures and the main outcome. Results: Our cohort consisted of 333 patients who underwent cardiac device extraction procedures. Cardiac device infection was the indication for procedure in 48% of patients (n=161). In-hospital mortality occurred in 9% of patients (n=29). Patients that died inpatient post-operatively were more likely to be male gender (OR 3.59, 95% CI [1.2, 10.6], p = 0.02), have acute kidney failure (OR 3.17, 95% CI [1.42, 7.05], p = 0.005), have anemia (OR 3.22, 95% CI [1.49, 6.99], p = 0.003), or have a diagnosis of severe malnutrition (OR 2.88, 95% CI [1.26, 6.58], p = 0.01). In a subgroup analysis, patients with diabetes undergoing extraction for infectious reasons had an increased risk of in-hospital mortality (OR 4.36, 95% CI [1.54, 12.34], p = 0.005). Conclusion: Patients undergoing cardiac device extraction are high risk for in-hospital mortality. Patients experiencing in-hospital mortality were more likely to be male, have acute renal failure, anemia and severe malnutrition. Careful analysis of preoperative risk factors, laboratory data, and nutritional status can help stratify risk for patients and providers.

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Thomas Butler ◽  
Akhlaq Khan ◽  
Abhishek Sengupta ◽  
Jonathan Sherman ◽  
Russell Denman ◽  
...  

Aim: This study sought to evaluate the impact of device extraction on the severity of TR in patients with cardiac device related infection (CDI) and infective endocarditis (CDRIE). Methods: The medical and echocardiographic records of 142 patients who had undergone device extraction for suspected infection from 2007 - 2013 were reviewed. Data on clinical complications, echocardiographic documentation of TR severity prior to and after device removal and potential risk factors for change in TR severity was obtained. A paired t test was used to evaluate whether the TR mean grade changed significantly. Patient Demographics: A total of 56 patients out of the 142 patients had TTE and/or TOE imaging. Of these patients, 22 patients had ICD’s, 27 patients had PPM’s and 7 patients had BiV Devices. The mean age was 62 years (47 males). Clinical complications included decompensated heart failure (12.5%), septic shock (8.9%), septic arthritis (8.9%), splenic abscess (1.78%), septic pulmonary embolism (5.35%), leukocytoclastic vasculitis (1.78%). Results: The mean duration of device in situ prior to extraction was 64 months (5.33yrs). The mean grade of TR prior to device extraction was grade 1.35/4 (SD=0.901, C.I. 1.16 to 1.72). The mean grade of TR post extraction was 1.54/4 (SD= 0.96 with C.I. 1.26 to 1.89). The mean difference in mean TR grade was 0.13 (C.I. 0.37 to -0.106) p >0.05. One patient had a worsening of TR by at least 2 grades post extraction. This was due to valve perforation from infection rather than extraction related trauma. This was the only patient that required surgery for clinically significant TR. Risk factors for worsening TR post extraction included the length of time leads were in situ and age of the patient. Time of Device in situ prior to extraction did not correlate significantly with severity of TR post procedure rho 0.12 (p value = 0.45). Furthermore, age at the time of the procedure did not correlate with tricuspid regurgitation severity post extraction rho 0.21 (p value = 0.18). Conclusions: Worsening of TR post extraction is uncommon and is more likely due to valve destruction from infection rather than trauma to the valve during extraction. Furthermore, a number of complications occur peri-procedurally that impacts on patient outcomes.


2021 ◽  
Vol 70 (Suppl-4) ◽  
pp. S871-75
Author(s):  
Muhammad Asad ◽  
Qurban Hussain Khan ◽  
Mir Waqas Baloch ◽  
Kumail Abbas Khan ◽  
Muhammad Amer Naseem ◽  
...  

Objective: Cardiac Implantable Electronic Devices are being implanted more commonly now compared to the past. Due to the rise in implantation rate complication have also considered to increase. One of the dreadful complications is devices infection. This study was conducted to assess retrospectively the rate of device infection and risk factors associated with it. Study Design: Observational study. Place and Duration of Study: AFIC/NIHD, Rawalpindi, from Jan 2018 to Jan 2019. Methodology: A total of 356 patients who underwent cardiac devices implantation. Their records were studied and all the patients who developed device infections were further reviewed in detail. Demographic details, clinical, laboratory data and imaging records were evaluated. Patients were classified into different categories of infections based on predefined criteria according to the guidelines. Risk factors were also taken into account. Results: Out of 356 devices 14 got infected and infection rate was 3.9%. Generator site infection was seen in 6 followed by generator erosion in 5 while 2 had pocket site infection with bacteremia and 1 developed pocket site infection with lead/valvular endocarditis. Dual chamber permanent pacemakers were infected the most. Denovo devices had high infection rate compared to replacement. Microbes were identified in 3 patients. Conclusions: Our findings suggest that the increasing incidence of Cardiac Implantable electronic devices infection in current clinical settings was multifactorial. Care should be taken at every step starting from preoperative, intraoperative to postoperative stage for prevention of device infection.


2021 ◽  
Vol 49 (6) ◽  
pp. 030006052110251
Author(s):  
Minqiang Huang ◽  
Ming Han ◽  
Wei Han ◽  
Lei Kuang

Objective We aimed to compare the efficacy and risks of proton pump inhibitor (PPI) versus histamine-2 receptor blocker (H2B) use for stress ulcer prophylaxis (SUP) in critically ill patients with sepsis and risk factors for gastrointestinal bleeding (GIB). Methods In this retrospective cohort study, we used the Medical Information Mart for Intensive Care III Clinical Database to identify critically ill adult patients with sepsis who had at least one risk factor for GIB and received either an H2B or PPI for ≥48 hours. Propensity score matching (PSM) was conducted to balance baseline characteristics. The primary outcome was in-hospital mortality. Results After 1:1 PSM, 1056 patients were included in the H2B and PPI groups. The PPI group had higher in-hospital mortality (23.8% vs. 17.5%), GIB (8.9% vs. 1.6%), and pneumonia (49.6% vs. 41.6%) rates than the H2B group. After adjusting for risk factors of GIB and pneumonia, PPI use was associated with a 1.28-times increased risk of in-hospital mortality, 5.89-times increased risk of GIB, and 1.32-times increased risk of pneumonia. Conclusions Among critically ill adult patients with sepsis at risk for GIB, SUP with PPIs was associated with higher in-hospital mortality and higher risk of GIB and pneumonia than H2Bs.


Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001526
Author(s):  
Elena Tessitore ◽  
David Carballo ◽  
Antoine Poncet ◽  
Nils Perrin ◽  
Cedric Follonier ◽  
...  

ObjectiveHistory of cardiovascular diseases (CVDs) may influence the prognosis of patients hospitalised for COVID-19. We investigated whether patients with previous CVD have increased risk of death and major adverse cardiovascular event (MACE) when hospitalised for COVID-19.MethodsWe included 839 patients with COVID-19 hospitalised at the University Hospitals of Geneva. Demographic characteristics, medical history, laboratory values, ECG at admission and medications at admission were collected based on electronic medical records. The primary outcome was a composite of in-hospital mortality or MACE.ResultsMedian age was 67 years, 453 (54%) were males and 277 (33%) had history of CVD. In total, 152 (18%) died and 687 (82%) were discharged, including 72 (9%) who survived a MACE. Patients with previous CVD were more at risk of composite outcomes 141/277 (51%) compared with those without CVD 83/562 (15%) (OR=6.0 (95% CI 4.3 to 8.4), p<0.001). Multivariate analyses showed that history of CVD remained an independent risk factor of in-hospital death or MACE (OR=2.4; (95% CI 1.6 to 3.5)), as did age (OR for a 10-year increase=2.2 (95% CI 1.9 to 2.6)), male gender (OR=1.6 (95% CI 1.1 to 2.3)), chronic obstructive pulmonary disease (OR=2.1 (95% CI 1.0 to 4.2)) and lung infiltration associated with COVID-19 at CT scan (OR=1.9 (95% CI 1.2 to 3.0)). History of CVD (OR=2.9 (95% CI 1.7 to 5)), age (OR=2.5 (95% CI 2.0 to 3.2)), male gender (OR=1.6 (95% CI 0.98 to 2.6)) and elevated C reactive protein (CRP) levels on admission (OR for a 10 mg/L increase=1.1 (95% CI 1.1 to 1.2)) were independent risk factors for mortality.ConclusionHistory of CVD is associated with higher in-hospital mortality and MACE in hospitalised patients with COVID-19. Other factors associated with higher in-hospital mortality are older age, male sex and elevated CRP on admission.


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Marco Iannetta ◽  
Francesco Buccisano ◽  
Daniela Fraboni ◽  
Vincenzo Malagnino ◽  
Laura Campogiani ◽  
...  

AbstractThe aim of this study was to evaluate the role of baseline lymphocyte subset counts in predicting the outcome and severity of COVID-19 patients. Hospitalized patients confirmed to be infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) were included and classified according to in-hospital mortality (survivors/nonsurvivors) and the maximal oxygen support/ventilation supply required (nonsevere/severe). Demographics, clinical and laboratory data, and peripheral blood lymphocyte subsets were retrospectively analyzed. Overall, 160 patients were retrospectively included in the study. T-lymphocyte subset (total CD3+, CD3+ CD4+, CD3+ CD8+, CD3+ CD4+ CD8+ double positive [DP] and CD3+ CD4− CD8− double negative [DN]) absolute counts were decreased in nonsurvivors and in patients with severe disease compared to survivors and nonsevere patients (p < 0.001). Multivariable logistic regression analysis showed that absolute counts of CD3+ T-lymphocytes < 524 cells/µl, CD3+ CD4+ < 369 cells/µl, and the number of T-lymphocyte subsets below the cutoff (T-lymphocyte subset index [TLSI]) were independent predictors of in-hospital mortality. Baseline T-lymphocyte subset counts and TLSI were also predictive of disease severity (CD3+  < 733 cells/µl; CD3+ CD4+ < 426 cells/µl; CD3+ CD8+ < 262 cells/µl; CD3+ DP < 4.5 cells/µl; CD3+ DN < 18.5 cells/µl). The evaluation of peripheral T-lymphocyte absolute counts in the early stages of COVID-19 might represent a useful tool for identifying patients at increased risk of unfavorable outcomes.


2021 ◽  
pp. jim-2021-001810
Author(s):  
Alejandro López-Escobar ◽  
Rodrigo Madurga ◽  
José María Castellano ◽  
Santiago Ruiz de Aguiar ◽  
Sara Velázquez ◽  
...  

The clinical impact of COVID-19 disease calls for the identification of routine variables to identify patients at increased risk of death. Current understanding of moderate-to-severe COVID-19 pathophysiology points toward an underlying cytokine release driving a hyperinflammatory and procoagulant state. In this scenario, white blood cells and platelets play a direct role as effectors of such inflammation and thrombotic response. We investigate whether hemogram-derived ratios such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio and the systemic immune-inflammation index may help to identify patients at risk of fatal outcomes. Activated platelets and neutrophils may be playing a decisive role during the thromboinflammatory phase of COVID-19 so, in addition, we introduce and validate a novel marker, the neutrophil-to-platelet ratio (NPR).Two thousand and eighty-eight hospitalized patients with COVID-19 admitted at any of the hospitals of HM Hospitales group in Spain, from March 1 to June 10, 2020, were categorized according to the primary outcome of in-hospital death.Baseline values, as well as the rate of increase of the four ratios analyzed were significantly higher at hospital admission in patients who died than in those who were discharged (p<0.0001). In multivariable logistic regression models, NLR (OR 1.05; 95% CI 1.02 to 1.08, p=0.00035) and NPR (OR 1.23; 95% CI 1.12 to 1.36, p<0.0001) were significantly and independently associated with in-hospital mortality.According to our results, hemogram-derived ratios obtained at hospital admission, as well as the rate of change during hospitalization, may easily detect, primarily using NLR and the novel NPR, patients with COVID-19 at high risk of in-hospital mortality.


2006 ◽  
Vol 124 (4) ◽  
pp. 186-191 ◽  
Author(s):  
Afonso Celso Pereira ◽  
Roberto Alexandre Franken ◽  
Sandra Regina Schwarzwälder Sprovieri ◽  
Valdir Golin

CONTEXT AND OBJECTIVE: There is uncertainty regarding the risk of major complications in patients with left ventricular (LV) infarction complicated by right ventricular (RV) involvement. The aim of this study was to evaluate the impact on hospital mortality and morbidity of right ventricular involvement among patients with acute left ventricular myocardial infarction. DESIGN AND SETTING: Prospective cohort study, at Emergency Care Unit of Hospital Central da Irmandade da Santa Casa de Misericórdia de São Paulo. METHODS: 183 patients with acute myocardial infarction participated in this study: 145 with LV infarction alone and 38 with both LV and RV infarction. The presence of complications and hospital death were compared between groups. RESULTS: 21% of the patients studied had LV + RV infarction. In this group, involvement of the dorsal and/or inferior wall was predominant on electrocardiogram (p < 0.0001). The frequencies of Killip class IV upon admission and 24 hours later were greater in the LV + RV group, along with electrical and hemodynamic complications, among others, and death. The probability of complications among the LV + RV patients was 9.7 times greater (odds ratio, OR = 9.7468; 95% confidence interval, CI: 2.8673 to 33.1325; p < 0.0001) and probability of death was 5.1 times greater (OR = 5.13; 95% CI: 2.2795 to 11.5510; p = 0.0001), in relation to patients with LV infarction alone. CONCLUSIONS: Patients with LV infarction with RV involvement present increased risk of early morbidity and mortality.


2021 ◽  
Author(s):  
Swathi Sangli ◽  
Misbah Baqir ◽  
Jay Ryu

Abstract ObjectiveThe objective of this study was to identify the predictors of in-hospital mortality among patients with diffuse alveolar hemorrhage (DAH).Patients and MethodsWe conducted a retrospective review of 89 patients hospitalized for DAH at our institution between 2001 and 2017: 49 patients who died during hospitalization and 40 patients who survived were compared. We reviewed their presenting signs and symptoms, clinical course, radiologic and pathologic findings, along with medical management. We then performed univariate and multivariate analyses to identify the risk factors associated with in-hospital mortality.ResultsWe identified 12 factors to be associated with mortality when comparing survivor vs non-survivor cohorts: smoking (27 [67%] vs 21 [42%], p = 0.02), malignancy (7 [17%] vs 24 [49%], p = 0.002), interstitial lung disease (0 vs 7 [14%], p = 0.01), liver failure (1 [2%] vs 14 [28%], p = 0.001), autoimmune diseases (16 [40%] vs 4 [8%], p =0.0006), thrombocytopenia (3 [7%] vs 35 [71%], p <0.0001), ICU admission (23 [57%] vs 40 [85%], p=0.004), mean duration of ICU stay (3.5 days [± 6.7] vs 5.5 days [± 5.5], p = 0.4), steroid use (36 [90%] vs 31 [63%], p = 0.003), use of plasma exchange (6 [15%] vs 0, p = 0.005), use of mechanical ventilation (15 [37%] vs 36 [75%], p value = 0.0007) and development of acute respiratory distress syndrome (ARDS) (9 [22%] vs 37 [77%], p <0.0001), respectively. On multivariate analysis, thrombocytopenia (OR 52.08: 95% CI, 8.59-315.71; p <0.0001) and ARDS (OR 11.71: 95% CI, 2.60-52.67; p = 0.0013) were associated with higher odds of mortality in DAH while steroid use (OR 0.05: 95% CI, 0.007-0.39; p = 0.0004) was associated with a lower risk of in-hospital mortality in patients with DAH.ConclusionIn DAH, thrombocytopenia and ARDS were predictors of in-hospital mortality whereas the use of steroid was associated with a more favorable prognosis.


2021 ◽  
Vol 18 (3) ◽  
pp. 86-93
Author(s):  
A. Yu. Bazarov ◽  
K. S. Sergeyev ◽  
A. O. Faryon ◽  
R. V. Paskov ◽  
I. A. Lebedev

Objective. To analyze lethal outcomes in patients with hematogenous vertebral osteomyelitis.Material and Methods. Study design: retrospective analysis of medical records. A total of 209 medical records of inpatients who underwent treatment for hematogenous vertebral osteomyelitis in 2006–2017 were analyzed. Out of them 68 patients (32.5 %) were treated conservatively, and 141 (67.5 %) – surgically. The risk factors for lethal outcomes were studied for various methods of treatment, and a statistical analysis was performed.Results. Hospital mortality (n = 9) was 4.3 %. In patients who died in hospital, average time for diagnosis making was 4 times less (p = 0.092). The main factors affecting mortality were diabetes mellitus (p = 0.033), type C lesion according to the Pola classification (p = 0.014) and age over 70 years (p = 0.006). To assess the relationship between hospital mortality and the revealed differences between the groups, a regression analysis was performed, which showed that factors associated with mortality were Pola type C.4 lesions (OR 9.73; 95 % CI 1.75–54.20), diabetes mellitus (OR 5.86; 95 % CI 1.14–30.15) and age over 70 years (OR 12.58; 95 % CI 2.50–63.34). The combination of these factors increased the likelihood of hospital mortality (p = 0.001). Sensitivity (77.8 %) and specificity (84.2 %) were calculated using the ROC curve. In the group with mortality, the comorbidity index (CCI) was significantly higher (≥4) than in the group without mortality (p = 0.002). With a CCI of 4 or more, the probability of hospital death increases significantly (OR 10.23; 95 % CI 2.06–50.82), p = 0.005. Long-term mortality was 4.3 % (n = 9), in 77.8 % of cases the cause was acute cardiovascular pathology, and no recurrence of vertebral osteomyelitis was detected.Conclusion. Hospital mortality was 4.3 %, and there was no mortality among patients treated conservatively. The main risk factors were diabetes mellitus, type C lesion according to Pola and age over 70 years. There was a significant mutual burdening of these factors (p = 0.001). With CCI ≥4, the probability of death is higher (p = 0.005).


2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S271-S271
Author(s):  
Gauri Chauhan ◽  
Nikunj M Vyas ◽  
Todd P Levin ◽  
Sungwook Kim

Abstract Background Vancomycin-resistant Enterococci (VRE) occurs with enhanced frequency in hospitalized patients and are usually associated with poor clinical outcomes. The purpose of this study was to evaluate the risk factors and clinical outcomes of patients with VRE infections. Methods This study was an IRB-approved multi-center retrospective chart review conducted at a three-hospital health system between August 2016-November 2018. Inclusion criteria were patients ≥18 years and admitted for ≥24 hours with cultures positive for VRE. Patients pregnant or colonized with VRE were excluded. The primary endpoint was to analyze the association of potential risk factors with all-cause in-hospital mortality (ACM) and 30-day readmission. The subgroup analysis focused on the association of risk factors with VRE bacteremia. The secondary endpoint was to evaluate the impact of different treatment groups of high dose daptomycin (HDD) (≥10 mg/kg/day) vs. low dose daptomycin (LDD) (< 10 mg/kg/day) vs. linezolid (LZD) on ACM and 30-day readmission. Subgroup analysis focused on the difference of length of stay (LOS), length of therapy (LOT), duration of bacteremia (DOB) and clinical success (CS) between the treatment groups. Results There were 81 patients included for analysis; overall mortality was observed at 16%. Utilizing multivariate logistic regression analyses, patients presenting from long-term care facilities (LTCF) were found to have increased risk for mortality (OR 4.125, 95% CI 1.149–14.814). No specific risk factors were associated with 30-day readmission. Patients with previous exposure to fluoroquinolones (FQ) and cephalosporins (CPS), nosocomial exposure and history of heart failure (HF) showed association with VRE bacteremia. ACM was similar between HDD vs. LDD vs. LZD (16.7% vs. 15.4% vs. 0%, P = 0.52). No differences were seen between LOS, LOT, CS, and DOB between the groups. Conclusion Admission from LTCFs was a risk factor associated with in-hospital mortality in VRE patients. Individuals with history of FQ, CPS and nosocomial exposure as well as history of HF showed increased risk of acquiring VRE bacteremia. There was no difference in ACM, LOS, LOT, and DOB between HDD, LDD and LZD. Disclosures All authors: No reported disclosures.


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