PMID- 32739256
OWN - NLM
STAT- MEDLINE
DCOM- 20210309
LR  - 20210714
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Linking)
VI  - 111
IP  - 3
DP  - 2021 Mar
TI  - Delineating Pathways to Death by Multisystem Organ Failure in Patients With a 
      Left Ventricular Assist Device.
PG  - 881-888
LID - S0003-4975(20)31221-2 [pii]
LID - 10.1016/j.athoracsur.2020.05.164 [doi]
AB  - 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.
CI  - Copyright (c) 2021 The Society of Thoracic Surgeons. Published by Elsevier Inc. All 
      rights reserved.
FAU - Seese, Laura
AU  - Seese L
AD  - Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, 
      Pennsylvania.
FAU - Movahedi, Faezeh
AU  - Movahedi F
AD  - Department of Electrical and Computer Engineering, University of Pittsburgh, 
      Pennsylvania.
FAU - Antaki, James
AU  - Antaki J
AD  - Department of Biomedical Engineering, Cornell University, Ithaca, New York.
FAU - Kilic, Arman
AU  - Kilic A
AD  - Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, 
      Pennsylvania.
FAU - Padman, Rema
AU  - Padman R
AD  - The Heinz College of Information Systems and Public Policy, Carnegie Mellon 
      University, Pittsburgh, Pennsylvania.
FAU - Zhang, Yiye
AU  - Zhang Y
AD  - Department of Healthcare Policy and Research, Weill Cornell Medicine, Ithaca, New 
      York.
FAU - Kanwar, Manreet
AU  - Kanwar M
AD  - Division of Heart Failure Cardiology, Allegheny General Hospital, Pittsburgh, 
      Pennsylvania.
FAU - Burki, Sarah
AU  - Burki S
AD  - Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, 
      Pennsylvania.
FAU - Sciortino, Christopher
AU  - Sciortino C
AD  - Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, 
      Pennsylvania.
FAU - Keebler, Mary
AU  - Keebler M
AD  - Division of Heart Failure Cardiology, University of Pittsburgh Medical Center, 
      Pittsburgh, Pennsylvania.
FAU - Hirji, Sameer
AU  - Hirji S
AD  - Division of General Surgery, Department of Surgery, Brigham and Women's Hospital, 
      Boston, Massachusetts.
FAU - Kormos, Robert
AU  - Kormos R
AD  - Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, 
      Pennsylvania. Electronic address: kormosrl@upmc.edu.
LA  - eng
GR  - R01 HL122639/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20200731
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
SB  - IM
MH  - Adult
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Failure/*surgery
MH  - Heart-Assist Devices/*adverse effects
MH  - Hospital Mortality/trends
MH  - Humans
MH  - Male
MH  - Multiple Organ Failure/etiology/*mortality
MH  - *Registries
MH  - Retrospective Studies
MH  - Survival Rate/trends
MH  - United States/epidemiology
MH  - Young Adult
EDAT- 2020/08/03 06:00
MHDA- 2021/03/10 06:00
CRDT- 2020/08/03 06:00
PHST- 2019/09/06 00:00 [received]
PHST- 2020/03/25 00:00 [revised]
PHST- 2020/05/27 00:00 [accepted]
PHST- 2020/08/03 06:00 [pubmed]
PHST- 2021/03/10 06:00 [medline]
PHST- 2020/08/03 06:00 [entrez]
AID - S0003-4975(20)31221-2 [pii]
AID - 10.1016/j.athoracsur.2020.05.164 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2021 Mar;111(3):881-888. doi: 10.1016/j.athoracsur.2020.05.164. 
      Epub 2020 Jul 31.