Craver, Emily C.

Abstract Background: Amyloidosis is a complex disease with a multitude of sequalae, particularly with the variants that cause cardiac amyloidosis. There is minimal literature on the types of procedures these patients undergo and the associated postprocedural outcomes. This gap of knowledge makes it difficult for anesthesia providers to risk stratify amyloidosis patients. Methods: This is a single-center, retrospective chart review study performed at a tertiary care medical center that serves as a referral center for patients with amyloidosis. Patients with a known diagnosis of transthyretin (ATTR) or light chain (AL) amyloidosis who underwent procedures requiring anesthesia between January 1, 2018 and October 24, 2024 were included in the study. The primary outcome was 30-day all-cause mortality. Secondary outcomes included other postoperative complications and analysis of types of procedures requiring anesthesia. Results: During the study period, 160 patients underwent a total of 466 procedures requiring anesthesia. Overall, 30-day mortality rate for all encounters was 1.7% (2.7% AL vs 0.5% ATTR, OR 5.71). Endoscopy was the most common procedure, accounting for 26.6% of all procedures. At the patient level, several procedures were more common in ATTR patients including TEE/Cardioversions (21.7% vs 6.6%, p=0.008), electrophysiology (36.2% vs 9.9%, p<0.001), and neurosurgery (13.0% vs 3.3%, p=0.031). Conclusions: In conclusion, patients with amyloid variants that cause cardiac amyloidosis carry substantial postoperative risk when undergoing procedures, with a trend toward increased mortality in patients with AL compared to ATTR. Patients with ATTR are more likely to require neurosurgery and treatment of arrythmias than patients with AL. Additional studies are needed to determine specific diagnostic parameters to help optimize these patients in the future. Trial Registration : Not applicable. Not a clinical trial

ABSTRACT Background Abdominal arterial calcification (AAC) is a common comorbidity in patients with end‐stage kidney disease (ESKD) and a predictor of cardiovascular events post‐kidney transplant. However, prior studies lacked a standardized approach to evaluate AAC and its impact on post‐transplant outcomes. This study aimed to correlate AAC score values with post‐kidney transplant outcomes using a modified scoring system traditionally applied to coronary artery calcification. Methods This retrospective study included 14 339 adult patients listed for kidney transplant between 2002 and 2023 at three transplant centers. Among them, 3683 patients met the criteria of undergoing a kidney transplant and an abdominal computed tomography (CT) scan pre‐transplant. We modified the coronary calcium score software by adjusting intake data points to quantify calcification in the abdominal aorta, common iliac, external iliac, and internal iliac arteries. Outcomes focused on post‐transplant mortality. Results In 3683 kidney transplant recipients, higher AAC scores were significantly associated with increased mortality. Each 1000‐unit increase in AAC score elevated hazard ratios (HRs) across arterial regions, including 1.116 for the aorta and 1.389 for the internal iliac (all p < 0.001). Adjusted analyses confirmed AAC as an independent risk factor for mortality. Kaplan–Meier curves demonstrated lower survival with increasing AAC quartiles. Conclusions AAC, measured by a standardized score, is a significant mortality risk factor in kidney transplant recipients. Integrating AAC scores into pre‐transplant evaluations could enhance risk stratification and improve outcomes. Prospective studies are needed to validate these findings and explore interventions to reduce AAC and improve survival.

Background: Procalcitonin (PCT) is recognized as an inflammatory biomarker, often elevated in COVID-19 pneumonia alongside other biomarkers. Understanding its association with severe outcomes and comparing its predictive ability with other biomarkers is crucial for clinical management. Objectives: This retrospective multicenter observational study aimed to investigate the association between PCT levels and adverse outcomes in hospitalized COVID-19 patients. Additionally, it sought to compare the predictive performance of various biomarkers. Design: The study analyzed data from the Society of Critical Care Medicine (SCCM) Viral Infection and Respiratory Illness Universal Study (VIRUS) registry, comprising COVID-19 patients hospitalized across multiple Mayo Clinic sites between March 2020 and June 2022. Methods: A total of 7851 adult COVID-19 patients were included. Patients were categorized into 6 groups based on the worst WHO ordinal scale. Multivariate models were constructed using peak biomarker levels within 72 hours of admission, adjusted for confounders. Results: Elevated PCT levels were independently associated with increased odds of adverse outcomes, including ICU admission (adjusted odds ratio [aOR] 1.32, 95%CI 1.27-1.38), IMV requirement (aOR 1.35, 95%CI: 1.28-1.42), and in-hospital mortality (aOR 1.30, 95%CI: 1.22-1.37). A 3.48-fold increase in IMV requirement and 3.55 times increase in in-hospital mortality were noted with peak PCT ⩾ 0.25 ng/ml. Similar associations were observed with other biomarkers like NLR (AUC 0.730), CRP, IL-6, LDH (AUC 0.800), and D-dimer (AUC 0.719). Models incorporating NLR, LDH, D-dimer, and PCT demonstrated the highest predictive accuracy, with a combined model exhibiting an area under the curve (AUC) of 0.826 (95%CI 0.803-0.849). Conclusions: Higher PCT levels were significantly linked to worse outcomes in COVID-19 patients, emphasizing its potential as a prognostic marker. Biomarker-based predictive models, particularly those including PCT, showed promising utility for risk assessment and clinical decision-making. Further prospective studies are warranted to validate these findings on a larger scale.

BACKGROUND AND OBJECTIVE There is limited research on screening for social determinants of health (SDOH) in hospitalized pediatric patients. In this article, we describe patient characteristics related to SDOH screening in the hospital setting and examine relationships with acute care metrics. METHODS This is a retrospective cohort study. From July 2020 to October 2021, a 14-question SDOH screener was administered to families of patients admitted or transferred to the hospital medicine service. Information was collected regarding screen results, demographics, patient comorbidities, patient complexity, and acute care metrics. Unadjusted and multivariable analyses were performed using generalized estimation equation logistic regression models. RESULTS Families in 2454 (65%) patient encounters completed SDOH screening, with ≥1 need identified in 662 (27%) encounters. Families with significant odds for positive screening results in a multivariable analysis included primary language other than English (odds ratio [OR] 4.269, confidence interval [CI] 1.731–10.533) or Spanish (OR 1.419, CI 1.050–1.918), families identifying as “Black” (OR 1.675, CI 1.237–2.266) or Hispanic (OR 1.347, CI 1.057–1.717) or having a child on the complex care registry (OR 1.466, CI 1.120–1.918). A positive screening result was not associated with increased length of stay, readmission, or 2-year emergency department or acute care utilization. CONCLUSIONS In hospitalized pediatric patients, populations at the greatest odds for positive needs include families with primary languages other than English or Spanish, those that identified as certain races or ethnicities, or those having a child on the complex care registry. A positive SDOH screening result in this study was not associated with an increase in length of stay, readmission, or acute care utilization.

ObjectiveThe aim was to evaluate representation of women in otolaryngology by examining authorship of research publications and presentations, awards, research grants, leadership, and membership in related organizations.MethodsAuthorship was reviewed from articles published in three otolaryngology journals from 2000 through 2021 to assess the frequency and percentages of female and combination of male and female gender authorship. Gender was evaluated for poster and scientific abstract presentations from 2007 to 2021. Gender representation was reviewed for institutional and society leadership positions, award, and grant recipients in the American Laryngological Society (ALA). Changes in the frequency of female and combination of male and female gender authorship over time were examined with Cochran‐Armitage test for trend.ResultsA total of 16,921 articles, 1,017 presentations, 480 leadership positions, 129 president positions, and 1,137 awards and grants were studied. Women were first authors in 4,153 (24.9%) and last authors in 2,935 (17.8%) published articles for which gender could be determined. Women were first authors in 372 (37.4%) presentations and last authors in 199 (20.2%). Most presentations had a combination of male and female presentation authorship (630, 68%). Women held 69 (14.4%) leadership positions. Of the award and grant recipients, 327 (28.8%) were female. Significant trends were observed for increasing female representation (first authorship publications increased 69.9% from 2000 to 2020, first authorship presentations increased 73.9% from 2007 to 2013, p < 0.001; leadership and awards from 3% to 18% representation, p = 0.02).ConclusionThe proportion of women receiving awards and holding leadership positions is increasing. Efforts that promote gender diversity may further increase representation of women in otolaryngology literature and among the grant and award winners.Level of EvidenceNA Laryngoscope, 134:2144–2152, 2024

AbstractBackgroundAfrican Americans (AA) represent 12% of the United States population ≥65 years‐old, but 19% of persons with dementia. Inequalities in social determinants of health may influence access to healthcare resources contributing to increased dementia risk. Modifiable risk factors, including vascular risk factors and depression, may contribute up to 40% of dementia risk and are overrepresented in AA. Accordingly, risk factor modification in AA may improve disparities and decrease dementia risk.MethodDementia risk factors were evaluated in community‐dwelling AA (n = 261) and non‐Hispanic White (NHW; n = 193) participants who completed ≥2 research visits in studies of memory and aging at the Mayo Clinic Florida Alzheimer Disease Research Center. The association between modifiable risk factors and cognitive impairment (global Clinical Dementia Rating® [CDR] ≥0.5), and rates of decline in impaired participants (measured using the CDR Sum‐of‐Boxes; CDR‐sb) were compared between AA and NHW, while controlling for demographics, APOEe4 status, and Area Deprivation Index.ResultModifiable dementia risk factors were common in AA and NHW participants. The ADI was higher in AA denoting greater socioeconomic and environmental deprivation [7.8 (2.3) vs. 4.0 (2.1); p<0.001]. History of stroke/transient ischemic attack (OR, CI95% = 2.52, 1.08‐5.83) was associated with an increased odds of dementia in AA participants only, while depression was associated with an increased odds of dementia in both AA (3.10, 1.52‐6.30) and NHW (3.46, 1.14‐10.48) participants. Moreover, depression (β, CI95% = 1.55, 0.5‐2.6), p = 0.004) was associated with a faster rate of decline (CDR‐sb) in cognitively impaired AA participants. AA participants with depression were disproportionately less likely to report use of antidepressant medications than NHW counterparts (40/45, 89% vs. 21/44, 48%); p<0.001).ConclusionModifiable risk factors associated with dementia were common in AA and NHW participants. Depression was associated with dementia in both AA and NHW but uniquely associated with an accelerated rate of cognitive decline in AA participants. Disparities in use of antidepressant medications may contribute to these differences. Optimizing depression treatment in AA communities may improve cognitive trajectories and dementia risk in this population.