Laura Seese1, Faezeh Movahedi2, James Antaki3, Arman Kilic1, Rema Padman4, Yiye Zhang5, Manreet Kanwar6, Sarah Burki1, Christopher Sciortino1, Mary Keebler7, Sameer Hirji8, Robert Kormos9. 1. Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 2. Department of Electrical and Computer Engineering, University of Pittsburgh, Pennsylvania. 3. Department of Biomedical Engineering, Cornell University, Ithaca, New York. 4. The Heinz College of Information Systems and Public Policy, Carnegie Mellon University, Pittsburgh, Pennsylvania. 5. Department of Healthcare Policy and Research, Weill Cornell Medicine, Ithaca, New York. 6. Division of Heart Failure Cardiology, Allegheny General Hospital, Pittsburgh, Pennsylvania. 7. Division of Heart Failure Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 8. Division of General Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts. 9. Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Electronic address: kormosrl@upmc.edu.
Abstract
BACKGROUND: This study delineates the sequences of adverse events (AEs) preceding mortality attributed to multisystem organ failure (MSOF) in patients with a left ventricular assist device (LVAD). METHODS: We analyzed 3765 AEs after 536 LVAD implants recorded in The Society of Thoracic Surgeons Intermacs data registry between 2006 and 2015 that resulted in MSOF death. Hierarchical clustering identified and visualized quantitatively unique clusters of patients with similar AE profiles. Markov modeling was used to illustrate the AE sequences that led to MSOF death within the clusters. Cox proportional hazard models determined the risk-adjusted, preimplant predictors of MSOF. RESULTS: We identified 2 distinct MSOF clusters based on their proportion of AE types and survival time. The early-death cluster (418 patients, 2304 AEs) had a median survival of 1 month (interquartile range, 3-6 months), whereas the late-death cluster (118 patients, 1,461 AEs) had a median survival of 11 months (interquartile range, 6-22 months). The predominant AE sequences in the early-death and late-death clusters were renal failure, to respiratory failure, to death (62%) and bleeding, to infection, to respiratory failure, to death (45%), respectively. Significant risk-adjusted preimplant predictors of MSOF included line sepsis (hazard ratio [HR] 3.0; 95% confidence interval [CI], 1.1-8.2), extracorporeal membrane oxygenation (HR, 2.2; 95% CI, 1.2-3.9), and dialysis or ultrafiltration (HR, 2.1; 95% CI, 1.5-3.0). CONCLUSIONS: This analysis identified 2 AE clusters and the predominant sequences that result in MSOF-associated mortality. MSOF develops in 1 cluster of patients after chronic bleeding and repeated infections but has prolonged survival, while another group dies early after renal and respiratory complications.
BACKGROUND: This study delineates the sequences of adverse events (AEs) preceding mortality attributed to multisystem organ failure (MSOF) in patients with a left ventricular assist device (LVAD). METHODS: We analyzed 3765 AEs after 536 LVAD implants recorded in The Society of Thoracic Surgeons Intermacs data registry between 2006 and 2015 that resulted in MSOF death. Hierarchical clustering identified and visualized quantitatively unique clusters of patients with similar AE profiles. Markov modeling was used to illustrate the AE sequences that led to MSOF death within the clusters. Cox proportional hazard models determined the risk-adjusted, preimplant predictors of MSOF. RESULTS: We identified 2 distinct MSOF clusters based on their proportion of AE types and survival time. The early-death cluster (418 patients, 2304 AEs) had a median survival of 1 month (interquartile range, 3-6 months), whereas the late-death cluster (118 patients, 1,461 AEs) had a median survival of 11 months (interquartile range, 6-22 months). The predominant AE sequences in the early-death and late-death clusters were renal failure, to respiratory failure, to death (62%) and bleeding, to infection, to respiratory failure, to death (45%), respectively. Significant risk-adjusted preimplant predictors of MSOF included line sepsis (hazard ratio [HR] 3.0; 95% confidence interval [CI], 1.1-8.2), extracorporeal membrane oxygenation (HR, 2.2; 95% CI, 1.2-3.9), and dialysis or ultrafiltration (HR, 2.1; 95% CI, 1.5-3.0). CONCLUSIONS: This analysis identified 2 AE clusters and the predominant sequences that result in MSOF-associated mortality. MSOF develops in 1 cluster of patients after chronic bleeding and repeated infections but has prolonged survival, while another group dies early after renal and respiratory complications.
Authors: Garrett N Coyan; Lauren V Huckaby; Carlos E Diaz-Castrillon; Alyssa M Miguelino; Arman Kilic Journal: J Card Surg Date: 2022-02-19 Impact factor: 1.620
Authors: J Hunter Mehaffey; Ryan Cantor; Susan Myers; Nicholas R Teman; John A Kern; Gorav Ailawadi; Francis Pagani; James Kirklin; Kenan Yount; Leora Yarboro Journal: JTCVS Open Date: 2022-01-22