KC, Anil

Abstract Disclosure: A. Omayer: None. A. Sharif: None. A. Kc: None. S. Hoque: None. H. BaniHani: None. L. Khaled: None. A. Holeihel: None. U.A. Khawaja: None. Background: Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus that is often managed with fluid resuscitation, insulin therapy, and correction of electrolyte imbalances. Bicarbonate therapy is commonly used to correct acidosis, but its effectiveness remains debated. This systematic review and meta-analysis aimed to assess the impact of bicarbonate therapy on clinical outcomes in DKA patients. Methods: Following the PRISMA guidelines, we performed a systematic review of studies assessing the use of bicarbonate therapy in DKA. We searched PubMed, Google Scholar, Cochrane Library, and ClinicalTrials.gov for studies published up to August 2024. Studies were included if they involved DKA patients with initial pH ≤7.30 or glucose >250 mg/dL, and compared bicarbonate therapy with standard care. Data on outcomes were extracted, including pH levels, duration of hospital stay, time to resolution of acidosis, potassium levels, and incidence of hypoglycemia. We performed a meta-analysis using RevMan, with a random-effects model for most outcomes and fixed-effects for specific analyses. The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS), Cochrane's ROB-2 tool and The Joanna Briggs Institute (JBI) Scale for cohort studies, randomized controlled trials (RCTs) and case series respectively. Results: Eight studies, including 646 patients, met the inclusion criteria. The included studies were conducted in various countries and represented diverse populations, with sample sizes ranging from 20 to 232 participants. Participants' mean ages spanned from approximately 9.7 years to 45.8 years. The proportion of male participants varied significantly, from 40.6% to 54.3%. Bicarbonate therapy did not significantly improve pH levels (mean difference = -0.02, 95% CI [-0.13, 0.09], p = 0.7), time to resolution of acidosis (mean difference = 0.09 hours, 95% CI [-2.6, 2.79], p = 0.95), or potassium levels (mean difference = -0.10, 95% CI [-0.49, 0.29], p = 0.61). Bicarbonate therapy was associated with a marginally longer duration of hospital stay (mean difference = 13.63 hours, 95% CI [0.23, 27.03], p = 0.05), although the overall effect size was small. No significant difference was observed in the incidence of hypoglycemia (odds ratio = 2.62, 95% CI [0.59, 11.63], p = 0.20). High heterogeneity was observed across most outcomes, mainly due to variability in study protocols and patient populations. Conclusion: Bicarbonate therapy in DKA does not appear to provide significant clinical benefits in pH correction, resolution of acidosis, or potassium balance and may lead to a slightly prolonged hospital stay. Given the high heterogeneity of included studies, further well-designed trials are needed to establish more precise guidelines on bicarbonate use in DKA management. Presentation: Saturday, July 12, 2025

Background: Supine hypertension, or elevated blood pressure while lying down, is often underrecognized in clinical settings. Though more common in older adults and those with autonomic dysfunction, its long-term cardiovascular impact remains unclear. Growing evidence suggests it may contribute to higher risks of cardiovascular disease (CVD), stroke, heart failure, and mortality. Methods: A meta-analysis evaluated the association between supine hypertension and primary cardiovascular outcomes were searched using standard electronic databases. MeSh term including “supine hypertension” and “cardiovascular outcomes” were used for Search. Studies reporting hazard ratios for CVD events, stroke, heart failure, cardiovascular, and all-cause mortality were included. Random-effect models were used for pooled analysis, with heterogeneity assessed using the I2 statistic and p value <0.05 considered significant. Results: A total of 13 studies were included in the analysis, comprising a combined study population of 241,765 individuals with a mean age of 59 years and follow up for 12.4 years. Cardiovascular Events: Six studies showed a significant association between supine hypertension and increased CVD events (HR = 1.41, 95% CI: 1.28–1.55, p<0.05). Cardiovascular Mortality: Five studies indicated elevated supine systolic BP was linked to higher cardiovascular mortality (HR = 1.57, 95% CI: 1.40–1.75, p<0.05). Heart Failure: Three studies demonstrated a strong, consistent association between supine hypertension and heart failure (HR = 1.83, 95% CI: 1.72–1.95, p<0.05). Mortality: Eight studies showed a modest but significant increase in all-cause mortality (HR = 1.23, 95% CI: 1.02–1.45, p<0.05). Stroke: Three studies revealed significantly increased stroke risk in individuals with supine hypertension versus standing hypotension (HR = 1.69, 95% CI: 1.41–1.97, p<0.05). Conclusion: Supine hypertension was significantly associated with increased risks of CVD events, cardiovascular mortality, stroke, heart failure, and all-cause mortality. These findings highlight the need to consider supine blood pressure patterns in clinical evaluations to improve risk detection and guide preventive care strategies.

e20551 Background: Lung cancer is leading cause of cancer related mortality globally, with non-small cell lung cancer (NSCLC) comprising approximately 80% of all cases. The combination of immune checkpoint inhibitors targeting programmed cell death protein 1 (PD-1) or its ligand (PD-L1), specifically Durvalumab, and anti-cytotoxic T-lymphocyte antigen 4 (CTLA-4) inhibitors, such as Tremelimumab has demonstrated clinical efficacy in both adjuvant and neoadjuvant settings. However, a comprehensive systematic review of the available data is currently lacking. This study aims to assess the therapeutic efficacy of Durvalumab combined with Tremelimumab in NSCLC focusing on key end points including progression-free survival, overall survival, overall response rate, and safety, with particular attention to any adverse events and mortality. Methods: A comprehensive literature search was performed to identify relevant studies published until March 2024 across PubMed, Google Scholar, and Embase databases. Outcomes were pooled using the random effects DerSimonian-Laird model and reported as hazard ratio (HR) with a 95% confidence interval. A p-value of less than 0.05 was considered statistically significant. Results: A total of 1600 patients with NSCLC were included in the analysis, with 825 patients receiving Durvalumab plus Tremelimumab, and 775 patient receiving Standard chemotherapy across four studies. For Efficacy, following parameters were statistically significant: Progression Free Survival HR 0.75, 95%CI: 0.59, 0.92; Overall Survival HR 0.8, 95%CI: 0.58, 0.99; Overall Response Rate HR: 0.68, 95%CI: 0.47, 0.88, Mean Duration of Response was 12.23 month. Safety outcomes revealed that Durvalumab plus Tremelimumab versus Standard chemotherapy were comparable in mean percentage in terms of following parameters: Any Adverse Event (85.1% vs 92.8%), Any Serious Adverse Event (28.9% vs 17.75%), any mortality (6.35% vs 3.4%), Adverse Event leading to discontinuation (11.6% vs 10.13%), Any treatment related adverse event (69.96% vs 85.6%) and Any Treatment Related Death (0.9% vs 0.3%). Conclusions: Efficacy outcomes in patients treated with Durvalumab plus Tremelimumab demonstrated clinically meaningful improvements while the safety profile was comparable to that of Standard chemotherapy. Given the increasing use of this combination therapy as adjuvant and neoadjuvant treatment for NSCLC, further clinical trials are warranted to confirm and validate these findings.

e24010 Background: Cancer increases the risk of atrial fibrillation (AF), particularly in patients over 65 or those with pre-existing cardiovascular disease. Patients with active cancer are at a higher risk of arterial and venous thrombosis. Oral anticoagulation (OAC) is recommended in most patients with comorbidities, based on the CHA2DS2-VASc score. However, because OAC raises the risk of bleeding, it might not be appropriate for patients who have significant or frequent bleeding episodes, vascular malformations, or other contraindications. Anticoagulation in cancer patients is challenging due to thrombocytopenia, bleeding risks, and interactions with chemotherapy. Left atrial appendage Closure (LAAC) offers an alternative to anticoagulation for mitigating stroke risk in nonvalvular AF patients. However, this procedure has been offered less frequently as concerns regarding its prognosis among cancer patients remain unclear. This article aims to find the prognosis of cancer patients with LAAC. Methods: A systematic search was conducted in electronic databases from inception until June 2024 using appropriate Mesh terms. Pooled risk ratios (RR) with their corresponding 95% confidence intervals (CI) were calculated using random effects models. A p-value of <0.05 was considered statistically significant. Results: A total of 5 studies with a population of 1,20,502 (Cancer Patients: 3803 and Non- Cancer patients: 116699) were included which met all the inclusion criteria. An increased risk of in-hospital mortality among cancer patients with LAAC (RR=1.90; 95% CI=1.05–3.45, P=0.03) with statistically significant was observed. However, other parameters were comparable including, 30 days readmission (RR=1.12; 95% CI=0.95–1.032), all-cause mortality (RR=1.33; 95% CI=0.72–1.95), any bleeding complication (RR=1.04; 95% CI=0.37–1.70), Cardiovascular complication (RR=1.44; 95% CI=0.51–4.06), thromboembolism (RR= 2.28; 95% CI=0.57–9.06), and neurological complication (RR=0.81; 95% CI=0.17–1.46). Conclusions: There were increased chances of in-hospital mortality among cancer patients than in non-cancer patients with LAAC procedures. However, other parameters like cardiovascular complications, any bleeding complications, thromboembolism, and neurological complications were not significantly associated. Further studies are warranted to validate these findings.

Background: Sarcoidosis is a multisystem disorder characterized by non-caseating granulomas in various organs. While cardiac sarcoidosis (CS) is clinically rare, it has significant implications, including heart failure, ventricular arrhythmias, and sudden cardiac death. Speckle-tracking echocardiography has emerged as a promising tool for detecting subclinical myocardial dysfunction, which is cost-efficient and readily available. This meta-analysis aims to evaluate differences in functional echocardiographic parameters between patients with CS and extracardiac sarcoidosis (ECS) to improve early recognition and management. Methods: A comprehensive search of major bibliographic databases was conducted to identify studies up to December 2024. Mean differences (MDs) with 95% CIs were pooled using the inverse-variance random-effect model. Results: Seven studies with 478 patients with sarcoidosis (CS: 159 and ECS: 319) were included. Patients with CS had a significant reduction in left ventricular global longitudinal strain (MD: −2.73; 95% CI: −4.09, −1.38; p < 0.0001) and tricuspid annular plane systolic excursion (MD: −0.59; 95% CI: −1.12, −0.05; p = 0.03) compared to patients with ECS. No significant differences in the LV global circumferential strain, interventricular septum thickness, left ventricular ejection fraction, E/A ratio, E/E’ ratio, LV end-diastolic diameter, and LV end-systolic diameter were noted. Conclusions: LV GLS and TAPSE are promising parameters for the early detection of cardiac involvement in sarcoidosis, with significant prognostic implications. Although STE provides a cost-effective and accessible alternative to CMR and FDG-PET, further research is needed to standardize its use and validate diagnostic cut-offs.

Background: Rivaroxaban is a novel oral anticoagulant suggested as an alternative to low molecular weight heparin (LMWH). However, its efficacy and safety compared to LMWH for treating venous thromboembolism (VTE) in cancer patients remain unclear. Hypothesis: This study aims to compare the efficacy and safety of rivaroxaban against LMWH for treating VTE in cancer patients. Methods: We conducted a literature search for relevant articles on PubMed, Google Scholar, and Embase. Outcomes were pooled using the DerSimonian and Laird random-effects model as risk ratios (RR) with 95% confidence intervals (CI). A p-value of <0.05 was considered statistically significant. Results: A total of 14368 cancer patients (Rivaroxaban: 4378 and LMWH: 9990) from 13 studies were included with an average age of 62.5 and 61.9 respectively. At 3 months, rivaroxaban was associated with a decreased risk of recurrent VTE (RR 0.73, 95% CI: 0.59, 0.86, p<0.05) and bleeding-related hospitalization (RR 0.79, 95% CI: 0.61, 0.97, p<0.05) with statistical signifcant whereas, major bleeding (RR 0.87, 95% CI: 0.09, 1.65), non-major bleeding (RR 0.84, 95% CI: 0.60, 1.08) and all-cause mortality (RR 0.91, 95% CI: 0.72, 1.09) were comparable. At 6 months, rivaroxaban was associated with a decreased risk of all-cause mortality (RR 0.80, 95% CI: 0.62, 0.97, p<0.05), and bleeding-related hospitalization (RR 0.81, 95% CI: 0.65, 0.98, p<0.05) whereas major bleeding (RR 0.88, 95% CI: 0.52, 1.24), non-major bleeding (RR 0.85, 95% CI: 0.42, 1.29) and recurrent VTE (RR 0.83, 95% CI: 0.64, 1.01) were comparable. At 12 months, rivaroxaban was associated with a decreased risk of mortality (RR 0.71, 95% CI: 0.50, 0.92, p<0.05), however non-major bleeding (RR 1.38, 95% CI: 0.83, 1.94), cancer-associated thrombosis recurrence (RR 0.94, 95% CI: 0.73, 1.16), and bleeding (RR 0.70, 95% CI: 0.26, 1.15) were comparable. Conclusion: While rivaroxaban is associated with low adverse outcomes suggesting its use in treating VTE in cancer patients, further research is recommended.