COVID-19 vaccination status should not be used in triage tie-breaking

This article discusses the triage response to the COVID-19 delta variant surge of 2021. One issue that distinguishes the delta wave from earlier surges is that by the time it became the predominant strain in the USA in July 2021, safe and effective vaccines against COVID-19 had been available for all US adults for several months. We consider whether healthcare professionals and triage committees would have been justified in prioritising patients with COVID-19 who are vaccinated above those who are unvaccinated in first-order or second-order triage. Given that lack of evidence for a correlation between short-term survival and vaccination, we argue that using vaccination status during first-order triage would be inconsistent with accepted triage standards. We then turn to notions of procedural fairness, equity and desert to argue that that there is also a lack of justification for using vaccination status in second-order triage. In planning for future surges, we recommend that medical institutions base their triage decisions on principles meant to save the most lives, minimise inequity and protect the public’s trust, which for the time being would not be served by the inclusion of vaccination status.

EFFICIENCY OF NORFLOXACIN IN THE PROPHYLAXIS OF HEPATORENAL SYNDROME

Purpose - to evaluate norfloxacin efficacy for the prevention of hepatorenal syndrome(HRS) development in patients with alcoholic liver cirrhosis and concomitant chronicpyelonephritis.Material and methods. In all, 157 patients, divided into two groups depending on themethod of HRS prevention, were examined: group 1 (n = 78) - received placebo; group 2(n = 79) - received norfloxacin. The main endpoint of the study was short-term survival.The probability curves were constructed using the Kaplan – Mayer method.Results. The rate of renal failure was much lower in group 2 (7 vs. 16 patients, p = 0.03).HRS was associated with bacterial infection in 4 patients of group 2 and in 6 patients ofgroup 1. HRS developed during the first 3 months of the follow-up period in 9 patientsin group 1 and only 1 patient in group 2 (p = 0.006). The incidence of HRS developmentduring the first 14 days was significantly lower in group 2. In all, 10 patients died ingroup 2 and 13 in group 1. The main cause of death in both groups was HRS (5 and8 patients, respectively). Mortality during the first 3 months was significantly higherin group 1 (10 vs. 2 patients, p = 0.02). Three-month (group 2 - 94%, group 1 - 62%)and annual survival (60% vs. 48%, respectively, p = 0.05) were significantly higher ingroup 2.Conclusions. Peroral antibiotic prophylaxis with norfloxacin almost 5 times reduces therisk of hepatorenal syndrome development type 1 in patients with alcoholic liver cirrhosisand concomitant chronic pyelonephritis, and increases their short-term survival.

Expression of lncRNA-ANRIL before and after Treatment and Its Predictive Value for Short-Term Survival in Patients with Coronary Heart Disease

This study aimed at observing the expression of lncRNA-ANRIL (ANRIL) before and after treatment and its predictive value for short-term survival in patients with coronary heart disease (CHD). Altogether, 112 patients with CHD admitted to the hospital were enrolled as a study group (SG), which was divided into a pretreatment study group (preSG) and a posttreatment study group (postSG). Further 72 healthy people undergoing physical examinations during the same period were enrolled as a control group (CG). Peripheral blood was collected from the subjects in the three groups, to detect the expression level of serum ANRIL using quantitative reverse transcription PCR (qRT-PCR). A receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic value of ANRIL for CHD. Kaplan-Meier survival curves were plotted to analyze 3-year survival rates in high- and low-ANRIL expression groups. Cox regression was conducted to analyze independent risk factors affecting the patients. The expression level of serum ANRIL in preSG was significantly lower than those in CG and postSG ( P < 0.05 ). According to the ROC curve, the area under the curve (AUC) of serum ANRIL for diagnosing CHD in CG was 0.894 and the optimal cutoff value was 0.639, with the sensitivity of 86.61% and the specificity of 93.67%. According to the survival curves, the 3-year overall survival rate in the high-ANRIL expression group was significantly lower than that in the low-expression group ( P < 0.05 ). History of smoking, high total cholesterol (TC), high triglyceride (TG), high homocysteine (Hcy), and ANRIL expression were independent prognostic factors affecting the overall survival time of the patients ( P < 0.05 ). ANRIL is poorly expressed in the peripheral blood of patients with CHD. Its detection has good sensitivity and specificity for diagnosing the disease, and its expression may be related to the poor prognosis of the patients.

COT-11 Relationship between preoperative liquid biopsy and prognosis of glioblastoma -Next Generation Sequencing of small noncoding RNA-

Background Non-invasive biomarkers are required in clinical practice of glioblastoma (GBM). We have previously reported the liquid biopsy for differentiating glioblastoma, central nervous system primary lymphoma and healthy control. In this study, we analyzed the relationship between the preoperative serum expression of circulating small non-coding RNAs and the prognosis of GBM patients. Methods Preoperative blood samples of GBM, IDH-wildtype patients (N=26) were centrifuged and collected all small RNAs in serum. The expression of small non-coding RNAs were analyzed using a next-generation sequencing system. The small non-coding RNAs that could predict short-term survivals in GBM patients were selected by the stepwise analysis. A diagnostic model was created using the combination of these RNAs and evaluated with ROC curve. Results GBM patients treated with adjuvant therapy of temozolomide and radiotherapy were divided into two groups: (1) a short-term survival group (N=11) with a survival time less than 15 months and (2) a long-term survival group (N=15) with a survival time more than 15 months. In the short-term survival group, the preoperative serum expression levels of small RNA-X and small RNA-Y were high, and the expression levels of small RNA-Z and small RNA-W were low. Using these four small non-coding RNAs, a prognostic model was created. The model was able to predict the short-term survival group of GBM patients with a sensitivity of 90.9% and specificity of 93.3% (AUC: 0.969). Conclusion The prognostic model developed with preoperative small non-coding RNA in GBM patients may be useful for estimating the survival of GBM patients treated with adjuvant therapy of temozolomide and radiotherapy.

287 Acute and late echocardiographic and cardiac MRI findings in multisystem inflammatory syndrome in children

Aims Multisystem Inflammatory Syndrome in Children (MIS-C) is a severe condition affecting children previously exposed to SARS-CoV-2. The aim of our study was to describe the acute and late cardiac abnormalities in patients with MIS-C, evaluated by speckle-tracking echocardiography (STE) and cardiac MRI (CMR). Methods and results Twenty-three (13 M, 10 F) patients with confirmed MIS-C diagnosis were recruited. All children underwent standard TTE, STE with analysis of LV global longitudinal strain (GLS). Seventeen (75%) were evaluated with CMR. All children received standard therapy. During follow-up echocardiography and CMR were repeated. Mean age was 8.1 ± 4 years. The majority (78.2%) was Caucasian. Cardiovascular symptoms were present in 10 (43.5%). Nine children (39.1%) shared Kawasaki Disease-like symptoms. Four patients (17.4%) needed ICU admission and three required inotropic support. Short-term survival was 100%. All patients showed a hyperinflammatory state. Tn-I was abnormal (&gt;34 ng/l) in 15 patients (65.2%), BNP was elevated in 20 (86.9%). Median time to STE evaluation was 8 days and to CMR 18 days since fever onset. Mean LVEF and RVEF were, respectively, 59 ± 10% and 45 ± 7%. Coronary dilation was observed in six (26.1%) patients. STE showed reduced mean LVGLS (−17 ± 4.3%). LVEF on CMR was 60 ± 13%, LGE with non-ischaemic pattern was evident in 6/17 patients (35.2%). Median time to follow-up was 49 days for echocardiography and 200 days for CMR since disease onset. STE showed improvement of LVGLS (−18.8 ± 2.2%), while CMR displayed persistence of LGE in two patients and reduction or absence in two of the six patients previously diagnosed. Conclusions The elevation of myocardial necrosis markers, the myocardial injury testified by reduced LVGLS and the presence of LGE on CMR in about a quarter of the patients support the hypothesis of a post-viral immune-mediated myocarditis-like pathogenesis of MIS-C. Early follow-up shows improvement of STE and CMR findings corroborating the evidence of excellent short-term survival.

Models To Predict The Short-Term Survival of Acute-On-Chronic Liver Failure Patients Following Liver Transplantation

Background: Acute-on-chronic liver failure (ACLF) is featured with rapid deterioration of chronic liver disease and poor short-term prognosis. Liver transplantation (LT) is recognized as the curative option for ACLF. However, there is no standard in the prediction of the short-term survival among ACLF patients following LT.Method: Preoperative data of 132 ACLF patients receiving LT at our center were investigated retrospectively. Cox regression was performed to determine the risk factors for short-term survival among ACLF patients following LT. Five conventional score systems (the MELD score, ABIC, CLIF-C OFs, CLIF-SOFAs and CLIF-C ACLFs) in forecasting short-term survival were estimated through the receiver operating characteristic (ROC). Four machine-learning (ML) models, including support vector machine (SVM), logistic regression (LR), multi-layer perceptron (MLP) and random forest (RF), were also established for short-term survival prediction.Results: Cox regression analysis demonstrated that creatinine (Cr) and international normalized ratio (INR) were the two independent predictors for short-term survival among ACLF patients following LT. The ROC curves showed that the area under the curve (AUC) ML models was much larger than that of conventional models in predicting short-term survival. Among conventional models the model for end stage liver disease (MELD) score had the highest AUC (0.704), while among ML models the RF model yielded the largest AUC (0.940). Conclusion:Compared with the traditional methods, the ML models showed good performance in the prediction of short-term prognosis among ACLF patients following LT and the RF model perform the best. It is promising to optimize organ allocation and promote transplant survival based on the prediction of ML models.

In-hospital Cardiac Arrest in Patients With Heart Failure: Long- and Short-term Survival and Trends

In patients with heart failure (HF) who suffered in-hospital cardiac arrest (IHCA), little is known about the characteristics, survival and neurological outcome. We used the Swedish Registry of Cardiopulmonary Resuscitation to study this, including patients aged ≥18 years suffering IHCA (2008-2019), categorised as HF alone, HF with acute myocardial infarction (AMI), AMI alone, or other. Odds ratios (OR) for 30-day survival, trends in 30-day survival, and the implication of HF phenotype was studied. 6378 patients had HF alone, 2111 had HF with AMI, 4210 had AMI alone. Crude 5-year survival was 9.6% for HF alone, 12.9% for HF with AMI and 34.6% for AMI alone. The 5-year survival was 7.9% for patients with HF and left ventricular ejection fraction (LVEF) ≥50%, 15.4% for LVEF <40% and 12.3% for LVEF 40-49%. Compared with AMI alone, adjusted OR (95% CI) for 30-day survival was 0.66 (0.60-0.74) for HF alone, and 0.49 (0.43-0.57) for HF with AMI. OR for 30-day survival in 2017-2019 compared with 2008-2010 were 1.55 (1.24-1.93) for AMI alone, 1.37 (1.00-1.87) for HF with AMI and 1.30 (1.07-1.58) for HF alone. Survivors with HF had good neurological outcome in 92% of cases.