FRÍAS, JORGE SINCLAIR DE

Abstract Rationale Transthoracic echocardiography (TTE) is a very useful measure of cardiac function in patients with pulmonary hypertension (PH), along with right heart catheterization, which is considered to be the gold standard of measurement. It is non-invasive, quick and a good screening tool to assess the function of a failing right ventricle against elevated pulmonary pressures. Portopulmonary hypertension (POPH) is defined as PH associated with portal hypertension. The Tricuspid Annular Plane Systolic Excursion to Systolic Pulmonary Artery Pressure (TAPSE/SPAP) ratio has been found to be an effective prognosticator in different subtypes of PH. This study focuses on the role of TAPSE/SPAP ratio in prognosis of patients with POPH undergoing liver transplantation. Methods This was a single-center retrospective study of POPH patients undergoing liver transplantation at Mayo Clinic Florida from June 2003 to December 2023. It included patients with POPH with a mean pulmonary pressure >20 mm Hg undergoing liver transplantation. Patients with incomplete TTE data, coexisting renal failure on dialysis and requiring liver retransplant were excluded. This study included 27 patients. The last TTE report before liver transplantation was used for data analysis. The TAPSE/SPAP ratio was investigated as predictor of all-cause mortality following liver transplant using Cox regression and area under ROC curve. (Brackets contain 95% C.I.) Time to death after liver transplantation was considered. Patients were followed till August 1, 2024. (The correlation of this ratio-TAPSE/SPAP with some catheterization measured pulmonary pressures and indices have been included in Table 1.) Results Among 27 patients, 13 were female, 14 male. The most common causes of liver failure in these patients were non alcoholic fatty liver disease (NASH) and alcoholic liver disease. Rarely, some etiologies like sarcoidosis, autoimmune hepatitis, primary sclerosing cholangitis and hepatitis B/C were present. There were 7 deaths among total of 27 patients. The hazard ratio (HR) of TAPSE/SPAP for overall mortality by Cox regression was 0.01 (0.00-0.58), p = 0.03. The area under ROC curve was 0.76 (0.55-0.96), p = 0.01 [Also for TAPSE alone, the area under ROC curve was 0.74 (0.51-0.97), p = 0.05] Conclusion This study infers that TAPSE/SPAP ratio seems to be a good predictor of survival in POPH patients undergoing liver transplant, with a higher ratio associated with decreased all-cause mortality. It suggests that TAPSE alone might also be a good predictor with higher TAPSE associated with decreased mortality. This abstract is funded by: None

AbstractNational performance metrics ultimately enhance patient decision‐making and promote meaningful improvements in health care delivery, which makes having valid and reliable measures essential. This study examined US News and World Report metrics from 2019 to 2012 and used electronic health record data, combined with detailed chart review across 3 in‐system hospitals, to assess the provision of care compared to the attribution of patients assigned to the ear, nose, and throat (ENT) mortality group. Of the initial 47 ENT‐attributed deaths, 23 of those were verified, dimensioning the mortality rate from 1.7% to just 0.8%. These results underscore the necessity of rethinking measures and mortality attribution methodologies to be more accurate. Current methods use Medicare Severity Diagnosis Related Group billing coding to map the attribution. We suggest transitioning away from specialty ranking approaches and towards a procedure and condition “rating” approach to ensure that these ranking types capture data about the provision of care within a given encounter.

Background The COVID-19 pandemic introduced unique challenges to healthcare systems, particularly in relation to patient safety and adverse events during hospitalization. There is limited understanding of COVID-19’s association with some patient safety indicators (PSIs). Objectives This study aimed to investigate the impact of COVID-19 infection on the rate of PSI-3 events and its implications on quality metrics. We compared PSI-3 event rates between COVID-19–infected and uninfected patients and examined the clinical characteristics of COVID-19 patients experiencing PSI-3 events. Methods This is a retrospective study at Mayo Clinic hospitals between January 2020 and February 2022, analyzing patients meeting PSI-3 denominator eligibility criteria. PSI-3 events were identified using AHRQ WinQI software. Patients were categorized based on COVID-19 status. Patient demographics, characteristics, and PSI-3 rates were compared. A case series analysis described clinical details of COVID-19 patients with PSI-3 events. Results Of 126,781 encounters meeting PSI-3 criteria, 8674 (6.8%) had acute COVID-19 infection. COVID-19–infected patients were older, more likely to be male, non-white, and had private insurance. PSI-3 rates were significantly higher in COVID-19 patients (0.21% versus 0.06%, P < 0.0001), even after risk adjustment (adjusted risk ratio, 3.24, P < 0.0001). The case series of 17 COVID-19 patients with PSI-3 events showed distinctive clinical characteristics, including higher medical device–related pressure injuries, and greater predisposition for head, face, and neck region. Conclusions Acute COVID-19 infection correlates with higher PSI-3 event rates. Current quality indicators may require adaptation to address the pandemic’s complexities and impact on patient safety. Further research is needed to comprehensively understand the intricate relationship between COVID-19 and patient outcomes.

Aim This study aims to evaluate the impact of frailty on the outcomes of older patients with pulmonary embolism (PE). Methods Using the National Inpatient Sample database, we identified 288 070 patients aged 65 or older who were admitted with a primary diagnosis of PE from 2017 to 2019. Frailty was assessed using the Hospital Frailty Risk Score (HFRS), and patients were categorized into low‐, intermediate‐, and high‐frailty‐risk groups. Multivariate logistic regression was used to calculate adjusted odds ratios for all outcomes. Results These patients were categorized into low‐risk (57.6%, 161 420), medium‐risk (39.9%, 111 805), and high‐risk (2.5%, 7075) groups. High‐risk patients, predominantly females with multiple comorbidities, exhibited significantly higher mortality rates and adverse outcomes. The HFRS showed a good discriminating ability in predicting mortality (area under the receiver operating characteristic curve = 0.7796). Frailty was associated with increased use of advanced therapeutic interventions and critical care resources such as thrombolysis, catheter‐directed therapies, inferior vena cava filter placement, mechanical ventilation, vasopressor use, and intensive care unit admission. Conclusion Frailty markedly affects outcomes in older PE patients. The HFRS offers a valuable prognostic tool in this population, suggesting that integrating frailty assessments into clinical practice could enhance care strategies and improve patient outcomes. Our findings underscore the need for further research to refine frailty‐based care paradigms. Geriatr Gerontol Int 2024; 24: 924–929 .

Myocardial infarction (MI) secondary to thrombolytic therapy in the setting of acute ischaemic stroke (AIS) is a rare but severe complication. This phenomenon has been well documented in the past with recombinant tissue-type plasminogen activator, also known as Alteplase. However, there are no documented reports of MI secondary to Tenecteplase (TNKase), an alternative thrombolytic agent rapidly gaining favour in managing AIS. We report a male patient in his 50s who received TNKase for an AIS and subsequently developed an inferolateral ST elevation MI.