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Abstract Background Despite a total decrease in age-adjusted mortality rate (AAMR) for HIV across all demographic variables, a multitude of factors have accounted for this cumulative effect of reduction in AAMR, including HIV-related hospitalizations, as 59% of these deaths occur in a medical facility. This study’s main objective is to provide insights from the national in-patient database for the recent years regarding the trends of HIV-associated in-hospital mortality and their healthcare resource utilization.Figure 1:(A). shows age-distribution of HIV-related hospitalizations (n=289,095); (B). gender; (C). age-groups; (D). racial/ethnic groups; (E). Trends in age-adjusted mortality rates among gender; (F). Trends in age-adjusted mortality rates among racial/ethnic groups.(A). Histogram (age).(B). Pie-chart (frequency).(C). Distribution dot-plot (horizontal).(D). Bar graph (vertical).(E). Line graph (two-groups).(F). Line graph (four-groups).Figure 2:Trend analysis for crude mortality of in-hospital HIV mortality among gender (A), race (B); inflation-adjusted hospitalization cost from 2016-2022 among gender (C), and race (D); and length of hospital stay among gender (E) and race (F).The Cochrane-Armitage test is used for crude mortality rate trend analysis for the years 2016 up to 2022.The Jonckheere-Terpstra test is used for non-parametric distribution of trends in length of stay and hospitalization costs (inflation-adjusted). Methods The National Inpatient Sample (NIS) database was searched from 2016 to 2022 to identify patients with HIV (ICD-10 Codes: B20-B24). Hospital discharge weights for national representation were utilized. Baseline social and demographic characteristics along with hospital-level variables were analyzed subsequently using the odds ratio with multivariate regression analysis for mortality adjusted with age. Secondary outcomes included length of hospital stay and inflation-adjusted costs. For cost-based analysis, inflation adjustment was performed according to the inflation index for the Medical Care Consumer Price Index (CPI).Figure 3:A-Univariate analysis of sociodemographic variables associated with in-hospital mortality with HIV; B-Significant predictors of in-hospital mortality with HIV in patients with comorbidities; C- Top 20 listed primary causes of admission stratified by ICD-10 codes in HIV patients.Top 20 listed primary causes of hospitalization in HIV patients from the year 2016 to 2022:1. B20 = HIV-related conditions.2. A41.9 = Sepsis, unspecified organism.3. J18.9 = Pneumonia, unspecified organism.4. N17.9 = Acute kidney failure, unspecified.5. J44.1 = Chronic obstructive pulmonary disease with (acute) exacerbation.6. U07.1 = COVID-19 infection.7. Z51.11 = Encounter for antineoplastic chemotherapy.8. I13.0 = Hypertensive heart and chronic kidney disease (CKD) with heart failure and stage 1 through stage 4 CKD.9. I10.0 = Hypertensive heart disease with heart failure.10. I21.4 = Non-ST elevation (NSTEMI) myocardial infarction.11. A41.89 = Other specified sepsis.12. I13.2 = Hypertensive heart and chronic kidney disease (CKD) with heart failure and with stage 5 CKD, or end-stage renal disease.13. F25.0 = Schizoaffective disorder, bipolar type.14. F33.2 = Major depressive disorder, recurrent severe without psychotic features.15. J96.01 = Acute respiratory failure with hypoxia.16. F10.239 Alcohol dependence with withdrawal, unspecified.17. O98.72 = HIV disease complicating childbirth.18. F25.9 = Schizoaffective disorder, unspecified.19. I12.0 = Hypertensive chronic kidney disease (CKD) with stage 5 (CKD) or end-stage renal disease.20. K52.9 = Noninfective gastroenteritis and colitis, unspecified.Table 1:Baseline characteristics of the study population.ED: emergency; HMO: health maintenance organization; DRG: diagnosis related groups; LOS: length of stay; SNF: skilled nursing facility; AMA: against medical device; NCHS: National Center for Health Statistics. Results A total of 289,095 HIV-related hospitalizations were included, which represents a weighted size of 1,445,475 hospital discharges. The mean age was 50.24 years, with 68.3% males and 51.85% African Americans. A total of 2.59% in-hospital deaths occurred; AAMR was 7029 per 100,000 hospitalizations in males, which was higher than females (5644 per 100,000). AAMR was found to be highest in the Hispanic population, at 8184 per 100,000. Males had a 3% annual percent change from 2016 to 2022, while trends show an increase in deaths in other races, like Asians/Pacific Islanders/Natives. Most deaths occurred in the West region (OR=1.43), non-metropolitan areas (OR=1.40), and medium-large bed-size hospitals (OR=1.28). Conclusion HIV-related in-hospital mortality has posed a significant challenge across various demographic factors. Utilizing mortality data from large databases can serve as a valuable screening tool for targeted public health surveillance and allocation of resources to obtain further development of tailored health programs and interventions aimed particularly at allocation of resources in reducing the impact of HIV-related deaths. Disclosures All Authors: No reported disclosures

Abstract Background Clostridium difficile infection (CDI) remains a significant public health concern in the United States, contributing to considerable morbidity and mortality, particularly among hospitalized and elderly populations. This study examines the temporal trends in CDI-related mortality across the United States over recent decades.Figure 1A:Mortality trends among gender; B: Race; C: US Census Region; D: Metropolitan areas. Mortality ratio (Gender): Female = 58.15% Male = 41.85% Mortality ratio (Race): Hispanic = 5.53% Whites = 83.92% Blacks = 8.12% Others = 2.22% Mortality ratio (US Census Region): Northeast = 22.18% Midwest = 24.36% South = 33.13% West = 20.33% Mortality ratio (Metropolitan): Metropolitan areas: 83.78% Non-metropolitan areas: 16.22%Figure 2A:Trends in mortality rates caused by Clostridium Difficile in United States from 1999-2020; and B: from 2021-2023. Top 90th percentile States (crude mortality rate per 100,000 population): Rhode Island: 6.55 Maine: 4.61 Ohio: 4.58 Vermont: 4.21 West Virginia: 4.18 Missouri: 4.11 Bottom 10th percentile States (crude mortality rate per 100,000 population): Georgia: 1.59 Mississippi: 1.49 Louisiana: 1.32 Utah: 1.26 Alaska: 0.96 Hawaii: 0.77 Methods In CDC WONDER analysis, we used total US residents of any age from all 50 states who died due to CDI spanning from the years 1999-2023. The dataset employed demographic attributes, place of death, state-level information, as well as classification into census regions, and the distinction between metropolitan and non-metropolitan localities. The ethnic/racial groups used in our study were classified as Hispanic, Black/African American, White, and others (including American Indian/Alaskan Native, Asian/Pacific Islander) individuals as indicated on the death certificates. US Census regions were categorized into Northeast, Midwest, South, and West based on the definitions provided by the Census Bureau.Figure 3:Place of death among individuals infection with clostridium difficile. Place of Death: Medical Facility - Inpatient: 71.22% Medical Facility - Outpatient or ER: 1.56% Medical Facility - Dead on Arrival: 0.06% Medical Facility - Status unknown: 0.03% Decedent's home: 5.52% Hospice facility: 4.64% Nursing home/long term care: 15.03% Other: 1.72% Place of death unknown: 0.22%Figure 4:Crude mortality rate among States. Crude mortality rate is represented per 100,000 population from the years 1999 to 2023. Results There were a total of 216,311 deaths associated with CDI over the study span. Out of them, 58.1% were females, 41.9% were males, 83.9% were White individuals, 8.12% were Black/African Americans, 5.53% were Hispanics, and 2.22% belonged to other racial groups. About 33% (one-thirds) of the deaths occured in South region followed by 24.4% in Midwest, 22.2% in Northeast and 20.3% in West region. According to NCHS rural-urban scheme classification, 83.8% deaths occured in metropolitan areas and the rest 16.2% in non-metropolitan areas. Conclusion National surveillance data indicate a marked increase in CDI-associated deaths during the early 2000s, largely driven by the emergence of hypervirulent strains and increased antibiotic resistance. However, recent years have shown a gradual decline in mortality rates, attributed to improved infection control practices, antimicrobial stewardship programs, and heightened public awareness. Despite these gains, disparities persist among racial, geographic, and age-specific subgroups, highlighting the need for targeted interventions. This underscores the evolving landscape of CDI mortality and the importance of sustained preventive strategies to further reduce the burden of this infection. Disclosures All Authors: No reported disclosures

BACKGROUND AND OBJECTIVES: Minimum clinically important differences (MCIDs) for patient-reported outcome metrics (PROMs) in patients with cervical spondylotic myelopathy (CSM) lack consensus on the most appropriate calculation method. This retrospective study aimed to identify the optimal MCIDs for commonly used PROMs in CSM. METHODS: The CSM database from the Quality Outcomes Database SpineCORe Study Group was analyzed. Baseline, 3-month, and 24-month PROM values for Neck Disability Index (NDI), 5-dimension Euro-quality of life (EQ-5D) in quality-adjusted life years, modified Japanese Orthopaedic Association (mJOA) score, and neck/arm pain numeric rating scale (NRS) were collected. MCIDs were calculated for each PROM using previously validated techniques. MCID values were compared using the area under the curve (AUC) with the North American Spine Society satisfaction scale as an anchor. RESULTS: A total of 1141 patients with CSM undergoing surgery were included in this analysis. Improvement of ≥30% from baseline was the optimal MCID for NDI and neck/arm NRS. At 24 months, the optimal percentage cutoff MCID for these instruments resulted in AUCs of 0.76, 0.72, and 0.67, similar to the 30% improvement method, with AUCs of 0.73, 0.71, and 0.67, respectively. Numeric cutoffs (0.065 at 3 months; 0.149 at 24 months) were the superior MCIDs for EQ-5D. For mJOA score, a severity-adjusted MCID outperformed other methods, yielding an AUC of 0.67 at 24 months. MCIDs were achieved in 63% of patients for NDI, 59% for neck pain NRS, 61% for arm pain NRS, 52% for EQ-5D, and 59% for mJOA score at 24 months. CONCLUSION: Using the Quality Outcomes Database SpineCORe data set, we defined optimal MCIDs for key PROMs in CSM. A ≥30% improvement from baseline was optimal in NDI and arm/neck NRS. An absolute numeric cutoff was superior for EQ-5D (0.149 at the 24-month follow-up). A severity-adjusted MCID performed best for mJOA score. These redefined benchmarks better capture the treatment impact and guide care decisions for patients with CSM.

Abstract Introduction Cardiovascular disease (CVD) is the leading cause of death among patients with kidney failure on dialysis. Social determinants of health may worsen this risk but are seldom incorporated into prognostic models. ICD-10 Z-codes provide standardized documentation of social determinants of health, yet their prognostic value in dialysis populations remains uncertain. This study examined whether Z-coded social determinants of health are associated with adverse cardiovascular outcomes and mortality among patients receiving dialysis for kidney failure. Methods A retrospective cohort study was conducted using the TriNetX Research Network (2010–2024), encompassing de-identified data from 103 institutions. Adults with kidney failure on chronic dialysis were stratified by the presence of ICD-10 Z-codes (Z55–Z65). Propensity score matching (1:1) balanced demographics, comorbidities, medications, and laboratory values. Primary outcomes were all-cause mortality and hospitalization; secondary outcomes included acute heart failure, myocardial infarction, stroke, cardiac arrest, bradyarrhythmias, and ventricular tachycardia. Results After matching, mean age was 62 years, and 42.4% were female in the Z-code cohort versus 41.2% in controls. Over one year, mortality occurred in 12.5% versus 10.9% (hazard ratio [HR], 1.22; 95% confidence interval [CI], 1.15–1.29) and all-cause hospitalizations in 57.3% versus 53.1% (HR, 1.22; 95% CI, 1.19–1.26). Cardiovascular complications were consistently higher in Z-coded patients, including heart failure (24.3% vs 20.5%; HR, 1.29), myocardial infarction (8.0% vs 7.1%; HR, 1.19), stroke (6.6% vs 6.2%; HR, 1.13), cardiac arrest (3.8% vs 3.1%; HR, 1.29), and bradyarrhythmias (6.9% vs 5.5%; HR, 1.33). Discussion Among patients with kidney failure, documented Z-coded social risk factors were associated with greater mortality and cardiovascular morbidity. Incorporating social determinants of health documentation into nephrology care may improve risk stratification and inform targeted interventions.

Abstract Introduction Cannabidiol has been shown to exert significant anti-inflammatory effects and has demonstrated efficacy in murine models of autoimmune myocarditis, pericarditis, and heart failure. The ARCHER Study assessed whether a pharmaceutically produced cannabidiol formulation showed beneficial effects on cardiac magnetic resonance (CMR) endpoints known to predict prognosis in this patient population. Methods In a multicentre international double-blind placebo-controlled phase 2 study, we randomly assigned 109 patients within 10 days of CMR confirmed diagnosis of acute myocarditis to 12 weeks of pharmaceutically produced oral cannabidiol (active) or placebo. Dose was titrated up to 10 mg/kg of body weight twice daily. Primary endpoints were the difference in extracellular volume (ECV) and global longitudinal strain (GLS) measured by CMR at week 12. Other CMR endpoints included left-ventricular ejection fraction (LVEF), LV mass, intracellular volume (ICV), LV end-diastolic and end-systolic volumes (LVEDV, LVESV), and left-atrial end-systolic volume (LAESV). Results All randomized patients (56 active/53 placebo) completed the study with no loss to follow-up. Study drug appeared safe and well tolerated. Baseline mean ECV 38.9 ± 10.9 ml, GLS −15.3 ± 3.6%, and LVEF 60.6 ± 9.9% were consistent with mild to moderate myocarditis and predominantly intact LV function. Week 12 mean ECV was 33.6 ml in the active group and 37.3 ml in the placebo group, a difference of −3.7 ml, confidence interval (CI): −7.4 to 0.1; P = .0538; GLS was −16.0% in the active group and −15.9% in the placebo group, difference of −0.1, CI: −1.2 to 1.1; P = .90. Left ventricular mass was significantly reduced in the active group at 121.1 g compared to placebo 130.3 g, a difference of −9.2, CI: −16.4 to −2.1; P = .0117. In terms of remodelling, LAESV was significantly reduced in the active group (−8.1 ml; P = .0376) while the reduction in LVEDV failed to reach significance (−7.4 ml; P = .098). Conclusion In mild-to-moderate acute myocarditis, treatment with pharmaceutically manufactured cannabidiol was not associated with a statistically significant change in myocardial ECV or GLS, although a trend towards reduction in ECV was observed. In addition, improvement in other potential markers of myocardial recovery, including a significant reduction in LV mass, was seen in the active treatment group. Further investigation of the therapeutic potential of this therapy in inflammatory cardiac conditions is warranted.

Abstract Older adults with dementia account over 15% of intensive care unit (ICU) admissions and face higher risks of functional decline and complications. We systematically evaluated the difference in ICU-related outcomes in patients with and without dementia, (e.g., mortality, resuscitation and code status decisions, complications, duration of life support and hospital stay). Searches were performed in MEDLINE, EMBASE, SCOPUS, and Web of Science between 2003 and 2024. A random-effects meta-analysis was done of odds ratios (OR) and mean differences (MD) and their corresponding 95% confidence intervals (CI) were calculated. Fifteen studies, including 1,231,037 patients (12% with dementia), met the inclusion criteria. Adjusted analysis showed that patients with dementia had a higher risk of ICU mortality (OR = 1.05, 95% CI 1.00–1.11), 30-day mortality (OR = 1.54, 95% CI 1.47–1.62) and 12-month mortality (OR = 1.95, 95% CI 1.88–2.02). They were less likely to receive mechanical ventilation (OR = 0.73, 95% CI 0.62–0.85, I2 0.0%) and more likely to develop delirium (OR = 4.80, 95% CI 1.81–12.72). In patients with dementia, ICU stays were slightly shorter (MD = –1 day, 95% CI –1.7 to –0.4), and discharge home was less common (OR = 0.40, 95% CI 0.39–0.42). Older adults with dementia experienced greater risk of mortality and delirium, alongside less aggressive intervention use and healthcare utilization (i.e., shorter ICU stays). These findings underscore the need for prospective studies to optimize ICU decision-making and post-discharge care for this vulnerable population.

ABSTRACT Introduction Metabolic dysfunction‐associated steatotic liver disease (MASLD) and steatohepatitis (MASH) represent a spectrum of liver conditions that can gradually progress to cirrhosis. Sodium‐glucose co‐transporter‐2 (SGLT‐2) inhibitors have shown benefits in reducing hepatic steatosis and liver‐related events in MASLD. This study aims to assess whether SGLT‐2 inhibitors are associated with a reduced risk of all‐cause mortality and disease‐specific outcomes in patients with MASH cirrhosis and type 2 diabetes (T2D). Methods A retrospective cohort study was performed using TriNetX. Patients with T2D and MASH cirrhosis on SGLT‐2 inhibitors were matched 1:1 with other glucose‐lowering drugs (oGLDs) based on demographics, comorbidities and medications. Primary outcomes included all‐cause mortality, hepatic decompensation and major adverse liver outcomes (MALO). Cox‐proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence interval (CI). Results A total of 51 427 patients with MASH cirrhosis and T2D were identified, of which 6833 (13.28%) were on SGLT‐2 inhibitors. Patients on SGLT‐2 inhibitors ( n = 6449, mean age 63.7 years, 52.9% female) were matched with 6449 individuals (mean age 63.9 years, 53.5% female) on oGLDs. The SGLT‐2 inhibitors cohort had statistically significantly lower risk of all‐cause mortality (HR: 0.58, 95% CI: 0.53–0.63), hepatic decompensation (HR: 0.85, 95% CI: 0.81–0.90) and MALO (HR: 0.88, 95% CI: 0.83–0.93). Conclusion SGLT‐2 inhibitors are associated with a reduced risk of all‐cause mortality in patients with MASH cirrhosis and T2DM, which may be partly attributable to a lower risk of hepatic decompensation and subsequent events. Further studies are warranted as SGLT‐2 inhibitors may serve as an adjunctive therapy for patients with MASH cirrhosis.

Abstract Castleman disease (CD) is a heterogeneous group of lymphoproliferative disorders anatomically classified by distribution (unicentric CD [UCD], oligocentric CD [oligoCD], or multicentric CD [MCD]). Human herpes virus 8–negative MCD is called idiopathic MCD (iMCD), which includes clinical subtypes with varying phenotypes and responses: TAFRO (thrombocytopenia, anasarca, fever, renal dysfunction and/or reticulin fibrosis, and organomegaly), IPL (idiopathic plasmacytic lymphadenopathy), and not otherwise specified. OligoCD has recently emerged as an intermediate form between UCD and MCD, with unclear clinical behavior, and IPL has not been validated in a Western cohort. We retrospectively analyzed 217 patients with CD evaluated at our institution between January 2004 and August 2024. Survival probabilities were compared using log-rank tests. Overall, 57% had UCD, 20% had oligoCD, and 23% had iMCD. Patients with oligoCD and iMCD more frequently exhibited systemic symptoms than those with UCD. Patients with oligoCD and iMCD had significantly shorter event-free survival (EFS) of 8.9 and 2.3 years, respectively, than those with UCD (not reached; P< .001 and P< .02). Among iMCD subtypes, iMCD-IPL demonstrated a longer EFS than iMCD-TAFRO (P = .02), with no deaths during the follow-up periods. The results validate oligoCD and iMCD-IPL as new subtypes in this Western cohort. The survival outcome in oligoCD was intermediate between UCD and iMCD, with only a subset of patients with oligoCD requiring systemic therapy. iMCD-IPL had a favorable survival outcome in this US cohort, similar to what has been reported in non-Western countries. Tailoring treatment strategies to disease subtypes and vigilant monitoring of oligoCD for progression may improve survival outcomes in CD.

Abstract Background & Aims: Alcohol is a leading global risk factor, over 200 diseases and injuries, but policy adoption varies. We updated the Alcohol Preparedness Index (API) to track global and regional policy trends from 2010–2019. Methods: Using WHO GISAH data for 141 countries, we scored five domains (policy frameworks; production/pricing/taxation; marketing/availability; drink-driving; monitoring/surveillance). The primary endpoint was % change in API. Trends were summarized by WHO region and correlates tested in adjusted regression. Results: In 2019, <25% of countries had a strong national alcohol plan and 40% had none. Production/pricing/taxation increased most (27%→78%); monitoring/surveillance reached strong levels in 47.5%. Median API increased from 57.0 [39.0–82.0] (2010) to 74.8 [58.3–83.5] (2016) and stayed above baseline in 2019 (67.8 [51.2–83.8]). Larger population predicted less API gain (β=−19.1, p<0.05); HDI and per-capita consumption did not. Conclusions: Global alcohol policy preparedness increased from 2010–2019.